Perioperative Anesthesia Management and Mortality Predictors in Pediatric Patients Undergoing Craniotomy for Cranial Tumors

Abstract

Aim: Studies investigating the effects of perioperative anesthesia management on outcomes in patients undergoing craniotomy for pediatric intracranial tumors are limited in the literature. Our aim in this study was to investigate the effects of perioperative anesthesia management on mortality. Secondly, other mortality predictors were investigated. Material and Method: A total of 165 patients aged <18 years who underwent craniotomy due to intracranial tumor in our hospital were included in the retrospective study between 01/2018 and 09/2024. Patients were divided into two groups according to the intraoperative anesthetic agents used. There were 58 patients in the sevoflurane group and 107 patients in the remifentanil and propofol groups. The primary endpoint was in-hospital mortality. Results: In the sevoflurane group, the mean age (2.5 [3] vs. 7 [8], p<0.001) and body weight (15 [13] vs. 25 [8], p<0.001) of the patients were lower. Sevoflurane was the preferred anesthetic agent instead of remifentanil in the younger age group. Therefore, the perioperative vital signs of the patients also differed at a statistically significant level (p<0.05 for each). In the univariable logistic regression analyses; weight (OR=0.866, 95% CI=0.771-0.971, p=0.014), blood transfusion (OR=13.143, 95% CI=1.624-106.333, p=0.016), need for inotropes (OR=19.125, 95% CI=2.378-153.835, p=0.006), and comorbid diseases (OR=4.681, 95% CI=1.080-20.297, p=0.039), were parameters associated with mortality. Conclusion: Our study found no link between perioperative anesthesia management and in-hospital mortality in pediatric patients who underwent craniotomy for intracranial tumors. However, low body weight, comorbidities, intraoperative blood transfusion, and inotropic support were associated with in-hospital mortality. Our study may help clinicians assess perioperative risk for patients who planned craniotomy.

Keywords

• Pediatric anesthesia
• craniotomy
• mortality

Kaynakça

1. Thakkar JP, McCarthy BJ, Villano JL. Age-specific cancer incidence rates increase through the oldest age groups. Am J Med Sci. 2014;348:65-70.
2. Sümpelmann R, Becke K, Crean P. Pediatric anesthesia practice in Europe: a survey of the European Society for Paediatric Anaesthesiology. Pediatric Anesthesia. 2017;27:811-9.
3. O'Kane R, Mathew R, Kenny T, et al. United Kingdom 30-day mortality rates after surgery for pediatric central nervous system tumors. J Neurosurg Pediatr. 2013;12:227-34.
4. Hankinson TC, Dudley RW, Torok MR, et al. Short-term mortality following surgical procedures for the diagnosis of pediatric brain tumors: outcome analysis in 5533 children from SEER, 2004-2011. J Neurosurg Pediatr. 2016;17:289-97.
5. Sletvold TP, Boland S, Schipmann S, Mahesparan R. Quality indicators for evaluating the 30-day postoperative outcome in pediatric brain tumor surgery: a 10-year single-center study and systematic review of the literature. J Neurosurg Pediatr. 2023;31:109-23.
6. Sherrod BA, Rocque BG. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery. J Neurosurg Pediatr. 2017;19:421-7.
7. Palaniswamy SR, Beniwal M, Venkataramaiah S, Srinivas D. Perioperative management of pediatric giant supratentorial tumors: challenges and management strategies. J Pediatr Neurosci. 2019;14:211-7.
8. Rath GP, Dash HH. Anaesthesia for neurosurgical procedures in paediatric patients. Indian J Anaesth. 2012;56:502-10.

9. Liu Y, Hu H, Han Y, et al. Body mass index has a nonlinear association with postoperative 30-day mortality in patients undergoing craniotomy for tumors in men: an analysis of data from the ACS NSQIP database. Front Endocrinol (Lausanne). 2022;13:868968.
10. He J, Jia L, Zhang Y, et al. Obesity paradox for postoperative mortality in young Chinese patients undergoing craniotomy for brain tumor resection. J Neurosurg Anesthesiol. 2023. doi: 10.1097/ANA.0000000000000932.
11. Tsang NM, Pai PC, Chuang CC, et al. Overweight and obesity predict better overall survival rates in cancer patients with distant metastases. Cancer Med. 2016;5:665-75.
12. Reichle K, Peter RS, Concin H, Nagel G. Associations of pre-diagnostic body mass index with overall and cancer-specific mortality in a large Austrian cohort. Cancer Causes Control. 2015;26:1643-52.
13. Acker SN, Nolan MM, Prendergast C, et al. Blood transfusion is associated with adverse outcomes in pediatric solid tumor oncology patients following tumor resection. J Pediatr Hematol Oncol. 2023;45:137-42.
14. Wang T, Luo L, Huang H, et al. Perioperative blood transfusion is associated with worse clinical outcomes in resected lung cancer. Ann Thorac Surg. 2014;97:1827-37.
15. Davidson J, Tong S, Hancock H, et al. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38:1184-90.
16. Favia I, Vitale V, Ricci Z. The vasoactive-inotropic score and levosimendan: time for LVIS?. J Cardiothorac Vasc Anesth. 2013;27:e15-6.
17. Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med. 2014;15:529-37.
18. Torres-Espíndola LM, Demetrio-Ríos J, Carmona-Aparicio L, et al. Comorbidity Index as a predictor of mortality in pediatric patients with solid tumors. Front Pediatr. 2019;7:48.
19. STARSurg Collaborative; EuroSurg Collaborative. Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe. Anaesthesia. 2024;79:945-56.
20. Hernández-Regino LM, De Jesús Castillejos-López M, Aquino-Gálvez A, et al. Clinical characteristics and mortality predictors of patients with cancer hospitalized by COVID-19 in a pediatric third-level referral center. Front Pediatr. 2022;10:960334.