Highlights
- •Volume effect in paediatric brain tumour resection surgery is inconsistent.
- •National inpatient database and penalised likelihood model were used.
- •The crude in-hospital mortality ratio was 1.8%, comparable to other countries.
- •The study indicated a volume effect in paediatric brain tumour resection surgery.
Abstract
Background
Paediatric brain tumours are the second most common type of malignancies that occur
during childhood. Surgical resection is usually the first step in the treatment of
these patients; however, evidence pertaining to a ‘volume effect’ in paediatric brain
tumour resection surgery and the associations among the surgical volume, clinical
features and treatments are not well characterised.
Methods
Data pertaining to paediatric patients (age ≤ 15 years) who underwent brain tumour
resection surgery between April 2012 and March 2016 were retrieved from the Japanese
administrative inpatient database and retrospectively analysed. Demographic characteristics,
therapeutic procedures and in-hospital mortality were summarised according to the
hospital surgical volume. Penalised logistic regression analysis was used to investigate
the association between the hospital surgical volume and in-hospital mortality.
Results
A total of 1354 paediatric patients were included. About 40% of the patients were
in the 11- to 15-year age group. The male:female ratio was 53:47, the overall crude
in-hospital mortality was 1.8% (n = 24) and the 30-day postoperative mortality was
0.4% (n = 6). The crude mortality ratio was 3.3% in the lowest quartile and 0.8% in
the highest quartile by volume. After adjusting for covariates, a higher hospital
surgical volume was associated with lower in-hospital mortality (compared with 1–4
surgeries per 4 years, 15–25 surgeries, odds ratio [OR]: 0.25; 95% confidence interval
[CI]: 0.05–0.90, p = 0.033; ≥26 surgeries, OR: 0.31; 95% CI: 0.08–0.96, p = 0.042).
Conclusions
The present study indicated a volume–outcome relationship in paediatric brain tumour
resection surgery cases. Further centralisation of surgeries should be considered
to achieve better outcomes.
Keywords
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Article info
Publication history
Published online: February 01, 2019
Accepted:
December 23,
2018
Received in revised form:
December 6,
2018
Received:
September 30,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
