Perioperative Complications Associated with Posterior Fossa Tumor Resection: a NSQIP-Peds Investigation

Introduction: Primary brain tumors are the leading cause of solid-tumor mortality in children, and over half of them are found in the posterior fossa. Surgical resection remains a primary treatment modality for these tumors. The rate of general perioperative complications in pediatric patients undergoing posterior fossa tumor resection, and factors related to complication probability, have not been well described. This study evaluates the relationships between clinical characteristics and complications associated with posterior fossa tumor resection, with the goal of establishing quality metrics to guide value-based care.

Methods: This retrospective cohort study utilized the National Surgical Quality Improvement Program - Pediatric database to track 30-day perioperative complications for patients younger than eighteen years of age who underwent surgical resection of a posterior fossa tumor. The primary outcome was the occurrence of a postsurgical complication within 30 days. A generalized additive model evaluated the relationship between clinical (e.g., malignant or benign tumor type) and surgical (e.g., CSF diversion, operating time) factors with 30-day complication occurrence.

Results: Preliminary data analysis revealed that of the 4,044 patients who met inclusion criteria, 1,314 (32.5%) experienced at least one perioperative complication. Variables associated with higher odds of complications included an ASA Status of IV or V, emergent or urgent surgery, ventricular catheter or CSF diversion, history of pulmonary conditions, prior cardiac surgery or cardiac risk factors, structural CNS abnormality, and prior nutrition support. The probability of complications was highest in patients < 1 year of age, relative to older patients. Longer operation times were positively associated with increased probability of perioperative complications.

Conclusion : These results suggest that several clinical and surgical factors are associated with a higher 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.