Volume effect in paediatric brain tumour resection surgery: analysis of data from the Japanese national inpatient database

Abstract

BackgroundPaediatric 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. MethodsData 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. ResultsA 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). ConclusionsThe 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.