OBJECTIVES

: Pediatric brain tumor is rare disease with wide range of histopathological classification. Brain tumor is second most common malignancy during childhood. Resection surgery is usually the first step in treating brain tumor in children. However, epidemiological studies of the surgery were scarce. The aim of the present study was to investigate clinical features and outcomes according to hospital surgical volume in pediatric patients who underwent brain tumor resection surgery.

METHODS

: We retrospectively analyzed pediatric patients, less than 16 years old, who underwent brain tumor resection surgery from the Japanese Diagnosis Procedure Combination database between April 2012 and March 2016. Patients who with outlier length of stay (>365days) and who with outlier preoperative length of stay (>14days) were excluded. We investigated the patients’ clinical characteristics, major procedures, and in-hospital mortality regarding hospital surgical volume. Subgroup analysis for patients aged 5 and younger was also performed.

RESULTS

: We identified 1,354 pediatric patients who underwent brain tumor resection surgery after exclusions. About two-fifth of the patients were aged 11-15 years old. Male/female ratio was 53/47. Overall crude in-hospital mortality was 1.8% (N = 24). Seventy-five hospitals provided just one surgery during study period. The crude in-hospital mortality tended to decreases as hospital surgical volume increased (3.3% in the lowest quartile volume, and 0.8% in the highest quartile volume). The tendency becomes more prominent in patients aged 5 years old and younger.

CONCLUSIONS

: The present study implies the volume-outcome relationship in pediatric brain tumor resection surgery although outcome analysis for this kind of surgery is complex due to its heterogeneity. Further centralization of the surgeries should be taken into consideration together with further efforts for risk-adjusted outcome analysis.