Newswise — The chances of good outcomes of surgery for children with brain tumors are better at hospitals that perform a high number of such procedures, reports a study in the March issue of Neurosurgery.

Based on a 12-year review of U.S. data, the study also suggests that more pediatric brain tumor operations are being performed at high-volume hospitals and by specialist surgeons, report Dr. Edward R. Smith and colleagues of Massachusetts General Hospital and Harvard Medical School. The researchers analyzed nationwide hospital data on 4,712 hospitalizations for brain tumor surgery in children from 1988 to 2000.

The risk of dying in the hospital was lower for children treated at hospitals that performed more pediatric brain tumor surgeries. This risk was 2.3 percent at hospitals that operated on less than four children with brain tumors per year, compared with 1.4 percent for hospitals that performed more than twenty such operations per year. With adjustment for other factors, the risk of in-hospital death decreased by half for every tenfold increase in the number of procedures performed.

The rate of in-hospital death was also lower for patients whose surgeons performed higher numbers of brain tumor surgeries on children, although this difference was not statistically significant. In another key outcome, children treated by high-volume hospitals or surgeons were more likely to be sent home after the operation, rather than to a rehabilitation hospital, long-term care center, or other facility.

Across all hospitals, the overall risk of in-hospital death was 1.6 percent. This risk decreased significantly during the study period: from 2.7 percent in 1988-90 to 1.2 percent in 1997-2000.

The data also showed trends toward increasing centralization and specialization of brain tumor surgery in children. In more recent years, a higher percentage of operations were performed at teaching hospitals and by surgeons specializing in pediatric surgery.

Previous studies have shown that the results of certain complex operations—such as cancer surgery and pediatric heart surgery—are better when the procedure is performed at high-volume hospitals that perform many such cases. The immediate outcomes of brain tumor surgery in children also appear better at high-volume hospitals, the new results suggest. The lack of follow-up data precludes any conclusions about the operations' final effectiveness.

During the 1990s, the percentage of operations done at large teaching hospitals and by specialists in pediatric surgery seems to have increased significantly. More research will be needed to determine whether these trends toward centralization and specialization will lead to further improvements in the outcomes of brain tumor surgery in children.

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Neurosurgery (Mar-2004)