Prospective insights into pediatric neurosurgery: transforming care through adverse event analysis

Recent advancements in pediatric neurosurgery have significantly enhanced patient care and monitoring. Despite these improvements, the complexity of these procedures continues to pose a high risk of adverse events (AEs). The current literature lacks comprehensive AE data, underscoring a critical gap in research. This study addresses this void by using a prospectively collected database from a premier neurosurgical tertiary center, aiming to develop critical care guidelines, optimize resource allocation, and foster interdisciplinary collaborations to mitigate AEs.

This prospective study enrolled pediatric patients undergoing neurosurgery between January 2020 and December 2023. AEs were defined as any undesirable outcomes occurring within 30 days postoperatively, with each event peer-reviewed at discharge.

Among the 1008 patients studied, ranging from newborns to 17-year-olds (mean age 10.5 years), 82.5% underwent elective procedures and 14.4% emergency procedures. The overall incidence of surgery-related AEs was 9.2%, with 5.2% requiring revision surgery. Cranial pathologies, accounting for 36.3% of interventions, were the most common, with wound infections and CSF leaks the most prevalent. The mortality rate was notably low at 0.4%, primarily attributable to severe underlying conditions such as medulloblastoma progression and severe traumatic brain injuries. Non-surgery-related AEs occurred at a rate of 2.4%. Logistic regression analysis identified age as a significant protective factor against postoperative complications, with each additional year reducing the odds of complications by approximately 5.4% (odds ratio 0.946, p = 0.002). Gender, however, was not a significant predictor of adverse outcomes.

The study highlights a significantly low incidence of AEs in pediatric neurosurgery, demonstrating the effectiveness of systematic AE documentation and continuous data monitoring. Logistic regression analysis identified age as a significant protective factor against complications, while gender showed no significant association, underscoring the multifactorial nature of AE development. These findings provide actionable insights into patient risk stratification, particularly emphasizing the role of age, and contribute to enhancing patient education, guiding quality-based healthcare reforms, and supporting the implementation of prospective AE tracking systems to improve patient safety and care standards in pediatric neurosurgery.