The Impact of Social Factors on Outcomes Following Pediatric Neuro-Oncology Surgery in the United States: A Systematic Review and Meta-Analysis

Introduction: Previous studies in the U.S. have assessed the effect of different social factors on outcomes following pediatric CNS tumor resection, but a robust review characterizing differences in post-operative outcomes by social factor has not been conducted. We sought to use an AI-assisted software to broadly recognize gender, racial, and socioeconomic differences in post-operative outcomes following pediatric neuro-oncology surgery.

Methods: PubMed, Scopus, Web of Science, Ovid were queried using a semi-automated software. Meta-analyses were performed to quantify pooled odds ratios for each outcome when reported: overall survival (OS) rate, subtotal resection rate (STR), 30-day readmission, recurrence, and medical complications (individual analyses for neurologic and endocrinologic complications). Where possible, sub-analyses were performed based on study type (case series versus cohort study) and tumor location (cranial versus spinal cord).

Results: 67 studies were included. Across all studies, white children experienced a greater OS rate (OR 0.70, p=0.0022), while non-white children more often had an STR (OR 1.16, p=0.001) and medical complication (OR 1.33, p=0.046). Patients on private insurance exhibited increased OS rates (OR 0.44, p< 0.001), whereas those with government insurance (OR 1.71, p=0.047) or lower household income (OR 1.25, p=0.001) had higher 30-day readmission rates. Considering study type sub-analyses, among case series, female patients were more likely to experience a medical complication (OR 1.94, p=0.019), specifically an endocrinologic complication (OR 2.56, 0.019), namely hypopituitarism (OR 3.30, p=0.033). Similarly, within cohort studies, girls undergoing cranial tumor resection more often experienced diabetes insipidus (OR 2.04, p=0.039).

Conclusion : Non-white, government-insured, and lower-income patients are more likely to experience an adverse peri-operative or medical complication. Female patients are more prone to endocrinologic complications post-operatively. This study identifies the importance of considering demographic variables during pre-operative risk assessment. Our findings warrant further granular analyses across varying tumor locations and types to elucidate parameters contributing to these disparities and explore interventions.