OBJECTIVES: To examine the prevalence rates of surgical complications among tuberous sclerosis complex (TSC) patients with surgical removal of subpendymal giant cell astrocytoma (SEGA). METHODS: Based on 3 US national health care claims databases (2000~2009), a retrospective cohort study was conducted in TSC patients who had a SEGA surgery at age 35 or younger, and were under continuous health insurance coverage 1 year before and 1 year after the surgery. A SEGA surgery was identified by a healthcare claim that simultaneously had a TSC diagnosis code, a benign brain tumor diagnosis code and a procedure code of removing a benign tumor from cerebral ventricle system. The surgical complications examined in the study included surgical procedure complications, nervous system complications, surgical misadventures, postoperative infection, subdural empyemas, and epidural abscess. The prevalence rates of these conditions were estimated for the first postoperative year. RESULTS: Approximately 47 TSC patients had at least one SEGA surgery. The mean age of patients at their 1st observed SEGA surgery was 11.6 years. The majority of patients (66%) were male. The prevalence rates of surgical complications in the 1st postoperative year were 34% for surgical procedure complications, 17% for subdural empyemas, 12.8% for nervous system complications, 6% for postoperative infection, 2% for epidural abscess, and 0% for surgical misadventures respectively. CONCLUSIONS: In this real-world claim database analysis, we observed that a portion of TSC patients experienced surgical complications within first year after their SEGA surgeries. Further research is needed to better understand the causes of this surgical outcome.