United Kingdom 30-day mortality rates after surgery for pediatric central nervous system tumors

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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%.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Short-term mortality following surgical procedures for the diagnosis of pediatric brain tumors: outcome analysis in 5533 children from SEER, 2004–2011

“…In both data sets young children did worse than older children, and again, like the 30-day data presented here compared with O'Kane and colleagues' study, outcomes were slightly better from the SEER data sets than the NRCT. 12,14 It is unclear why the 30-day mortality rate would be different between the UK and the US. As O'Kane and colleagues have stated previously, this might be a statistical anomaly because of the relatively small number of outcome events (i.e., deaths) that occur in the first 30 days after surgery.…”

“…2,9,15 Entities that assess quality, such as US News and World Report and the American College of Surgeons National Quality Improvement Program (ACS NSQIP), employ metrics of shortterm outcome, such as mortality or return to the operat-ing room within 30 days. 3,14 As a measure of short-term surgical outcomes, 30-day mortality rate offers the advantage of temporal proximity to the intervention in question. This provides both ease of data collection and the intuitive sense of a direct relationship between the intervention and the outcome.…”

“…European population-based studies recently reported all-cause 30-day mortality rates following craniotomy for pediatric brain tumors to be 1.4%-2.7%. 14,17 These studies acknowledge that such low rates limit the statistical power of the analyses. O'Kane and colleagues 14 also noted a substantially higher 30-day mortality rate in the UK population, when compared with the Norwegian population (2.7% versus 1.4%), but were not able to explain this difference.…”

“…14,17 These studies acknowledge that such low rates limit the statistical power of the analyses. O'Kane and colleagues 14 also noted a substantially higher 30-day mortality rate in the UK population, when compared with the Norwegian population (2.7% versus 1.4%), but were not able to explain this difference. This uncertainty prompted us to explore whether short-term mortality rates were well established in the US population.…”

Designing a safe and sustainable pediatric neurosurgical practice: the English experience

“…An ability to measure the impact of the Safe and Sustainable process was essential, and reliable data were required . For TBI, the process stated that there must be mandatory reporting of mortality and/or modified Glasgow Outcome Score at predefined time‐points and within specific diagnostic groups, transfer times and length of stay in relation to severity .…”