O'Kane Roddy, Mathew Ryan, Kenny Tom, Stiller Charles, Chumas Paul
Department of Neurosurgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK.
J Neurosurg Pediatr. 2013 Sep;12(3):227-34. doi: 10.3171/2013.5.PEDS12514. Epub 2013 Jun 28.
In an increasing culture of medical accountability, 30-day operative mortality rates remain one of the most objective measurements reported for the surgical field. The authors report population-based 30-day postoperative mortality rates among children who had undergone CNS tumor surgery in the United Kingdom.
To determine overall 30-day operative mortality rates, the authors analyzed the National Registry of Childhood Tumors for CNS tumors for the period 2004-2007. The operative mortality rate for each tumor category was derived. In addition, comparison was made with the 30-day operative mortality rates after CNS tumor surgery reported in the contemporary literature. Finally, by use of a funnel plot, institutional performance for 30-day operative mortality was compared for all units across the United Kingdom.
The overall 30-day operative mortality rate for children undergoing CNS tumor surgery in the United Kingdom during the study period was 2.7%. When only malignant CNS tumors were analyzed, the rate increased to 3.5%. One third of the deaths occurred after discharge from the hospital in which the surgery had been performed. The highest 30-day operative mortality rate (19%) was for patients with choroid plexus carcinomas. A total of 20 institutions performed CNS tumor surgery during the study period. Rates for all institutions fell within 2 SDs. No trend associating operative mortality rates and institutional volume was found. In comparison, review of the contemporary literature suggests that the postoperative mortality rate should be approximately 1%.
The authors believe this to be the first report of national 30-day surgical mortality rates specifically for children with CNS tumors. The study raises questions about the 30-day mortality rate among children undergoing surgery for CNS tumors. International consensus should be reached on a minimum data set for outcomes and should include 30-day operative mortality rates.
在医疗问责制不断加强的背景下，30天手术死亡率仍是外科领域报告的最客观的衡量指标之一。作者报告了英国接受中枢神经系统肿瘤手术儿童的基于人群的30天术后死亡率。
为确定总体30天手术死亡率，作者分析了2004 - 2007年期间国家儿童肿瘤登记处的中枢神经系统肿瘤数据。得出了每种肿瘤类型的手术死亡率。此外，还与当代文献中报告的中枢神经系统肿瘤手术后的30天手术死亡率进行了比较。最后，通过使用漏斗图，比较了英国所有单位30天手术死亡率的机构表现。
在研究期间，英国接受中枢神经系统肿瘤手术儿童的总体30天手术死亡率为2.7%。仅分析恶性中枢神经系统肿瘤时，该比率升至3.5%。三分之一的死亡发生在手术医院出院后。脉络丛癌患者的30天手术死亡率最高（19%）。在研究期间，共有20家机构进行了中枢神经系统肿瘤手术。所有机构的比率都在2个标准差范围内。未发现手术死亡率与机构手术量之间的关联趋势。相比之下，当代文献综述表明术后死亡率应约为1%。
作者认为这是第一份专门针对中枢神经系统肿瘤儿童的全国30天手术死亡率报告。该研究对接受中枢神经系统肿瘤手术儿童的30天死亡率提出了疑问。应就结果的最低数据集达成国际共识，其中应包括30天手术死亡率。
