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United Kingdom 30-day mortality rates after surgery for pediatric central nervous system tumors
Roddy O'Kane1, Ryan Mathew, Tom Kenny
1Department of Neurosurgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK.
Insights
The 30-day operative mortality rate for pediatric central nervous system (CNS) tumor surgery in the UK was 2.7%, higher than the 1% suggested by literature. This study highlights the need for standardized outcome reporting in pediatric neurosurgery.
Area of Science:
- Pediatric Neurosurgery
- Surgical Outcomes Research
- Oncology
Background:
- Medical accountability emphasizes objective surgical outcome metrics.
- 30-day operative mortality is a key indicator in surgical fields.
- Pediatric central nervous system (CNS) tumors represent a significant challenge in pediatric oncology.
Purpose of the Study:
- To report population-based 30-day postoperative mortality rates for pediatric CNS tumor surgery in the United Kingdom.
- To compare UK rates with contemporary literature benchmarks.
- To assess institutional performance variations in 30-day operative mortality.
Main Methods:
- Analysis of the National Registry of Childhood Tumors (2004-2007) for CNS tumors.
- Derivation of operative mortality rates by tumor category.
- Comparison with published literature rates.
- Use of funnel plots to evaluate institutional performance and volume.
Main Results:
- Overall 30-day operative mortality was 2.7% for pediatric CNS tumor surgery.
- Mortality increased to 3.5% for malignant CNS tumors.
- One-third of deaths occurred post-discharge; choroid plexus carcinomas had the highest rate (19%).
- No association found between institutional volume and mortality; all institutions performed within expected ranges.
Conclusions:
- This is the first national report on 30-day surgical mortality for pediatric CNS tumors.
- The findings raise concerns regarding current 30-day mortality rates in this population.
- International consensus is needed for a minimum data set including 30-day operative mortality.
Object:
In an increasing culture of medical accountability, 30-day operative mortality rates remain one of the most objective measurements reported for the surgical field. The authors report population-based 30-day postoperative mortality rates among children who had undergone CNS tumor surgery in the United Kingdom.
Methods:
To determine overall 30-day operative mortality rates, the authors analyzed the National Registry of Childhood Tumors for CNS tumors for the period 2004-2007. The operative mortality rate for each tumor category was derived. In addition, comparison was made with the 30-day operative mortality rates after CNS tumor surgery reported in the contemporary literature. Finally, by use of a funnel plot, institutional performance for 30-day operative mortality was compared for all units across the United Kingdom.
Results:
The overall 30-day operative mortality rate for children undergoing CNS tumor surgery in the United Kingdom during the study period was 2.7%. When only malignant CNS tumors were analyzed, the rate increased to 3.5%. One third of the deaths occurred after discharge from the hospital in which the surgery had been performed. The highest 30-day operative mortality rate (19%) was for patients with choroid plexus carcinomas. A total of 20 institutions performed CNS tumor surgery during the study period. Rates for all institutions fell within 2 SDs. No trend associating operative mortality rates and institutional volume was found. In comparison, review of the contemporary literature suggests that the postoperative mortality rate should be approximately 1%.
Conclusions:
The authors believe this to be the first report of national 30-day surgical mortality rates specifically for children with CNS tumors. The study raises questions about the 30-day mortality rate among children undergoing surgery for CNS tumors. International consensus should be reached on a minimum data set for outcomes and should include 30-day operative mortality rates.
