Perioperative complications associated with posterior fossa tumor resection: an observational study leveraging NSQIP Pediatric data

OBJECTIVE: The posterior fossa is the most common location for primary brain tumors in pediatric patients, and these infratentorial lesions are the leading cause of solid-tumor mortality. Resection remains a cornerstone of managing many of these tumors. However, the overall rate of perioperative complications in pediatric patients who have undergone posterior fossa tumor resection and the associated risk factors have not been explored. Therefore, the authors of this paper aimed to explore the association between clinical characteristics and the likelihood of complications with the intention of guiding patient counseling and directing areas for quality improvement to expand value-based care. METHODS: This is a retrospective cohort study utilizing the National Surgical Quality Improvement Program Pediatric data from 2012 to 2022 to track 30-day perioperative complications in patients 18 years of age or younger who underwent posterior fossa tumor resection. The primary outcome was postsurgical complications within 30 days. A generalized additive model was used to evaluate the relationship of clinical (e.g., age, pulmonary or cardiac conditions) and surgical (e.g., CSF diversion, operating time) factors with 30-day complications. RESULTS: Approximately 1 in 3 pediatric patients (1314/4044) experienced a perioperative complication within 30 days of posterior fossa tumor resection. The most common complications were bleeding or a need for transfusion (15.0%) and unplanned reoperation (14.6%). The rate of unplanned, related readmissions within 30 days was 8.5%. Variables significantly associated with greater odds of complications included an American Society of Anesthesiologists status of IV or V, emergent or urgent surgery, malignant tumor, sepsis/septic shock/systemic inflammatory response syndrome, structural CNS abnormality, steroid use, the need for ventricular catheter or CSF diversion, a history of pulmonary conditions, and a history of nutritional support. The probability of complications was highest in patients younger than 1 year of age relative to that in older patients. Longer operation times were also associated with an increased probability of perioperative complications. CONCLUSIONS: While high, the perioperative complication rate of 33% is comparable to previously reported rates for pediatric intracranial tumor resection in smaller sample sizes. The study results suggest that several clinical and surgical factors are associated with a greater risk of perioperative complications in children undergoing posterior fossa tumor resection. Understanding the impact that this has on surgical morbidity can inform risk stratification and presurgical counseling for patients and their families.