Perioperative outcomes and risk stratification following pediatric arteriovenous malformation resection: an ACS NSQIP-P database analysis.

Abstract

Purpose: To characterize the 30-day postoperative outcomes following craniotomy for AVM resection in pediatric patients and to elucidate independent predictors of adverse events using a large, multi-institutional database.

Methods: We performed a retrospective analysis utilizing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2015-2023). Pediatric patients undergoing AVM resection were identified using a combination of CPT codes and ICD codes. The primary outcomes comprised a composite of 30-day mortality, complications, unplanned reoperation, readmission, non-home discharge, and extended length of stay. Multivariable logistic regression (Wald test; p < 0.05) was employed to identify independent predictors.

Results: Analysis of 930 pediatric patients (median age 12.1 years, IQR 9.0-14.0) revealed that 34.3% experienced adverse outcomes within 30 days postoperatively. The observed mortality rate was 0.6%. Emergent surgical intervention demonstrated the strongest association with adverse outcomes (OR 8.58; 95% CI 5.12-14.37; p < 0.001), followed by preoperative ventilator dependence (OR 30.92; 95% CI 11.09-86.26; p < 0.001) and oxygen support requirements (OR 18.88; 95% CI 7.40-48.19; p < 0.001). Each additional minute of operative time conferred increased risk (OR 1.002/min; 95% CI 1.001-1.003; p < 0.001). Notably, we identified significant racial disparities, with African American/Black patients demonstrating an increased risk (OR, 1.65; 95% CI, 1.07-2.53; p = 0.023), while Hispanic ethnicity was associated with reduced adverse outcomes (OR, 0.73; 95% CI 0.53-1.00; p = 0.047).

Conclusion: These findings demonstrate that adverse outcomes following pediatric AVM resection are significantly influenced by surgical urgency, preoperative cardiopulmonary status, and operative complexity. The identification of potentially modifiable risk factors, particularly nutritional status and cardiopulmonary optimization, provides tangible targets for preoperative intervention. The observed racial disparities underscore the critical need for equitable, risk-stratified care paradigms in this vulnerable population.