High importance
Sep 23, 2026
To characterize 30-day postoperative outcomes following craniotomy for arteriovenous malformation (AVM) resection in pediatric patients and identify independent predictors of adverse events.
A retrospective analysis of the NSQIP-P database (2015-2023) was conducted, identifying pediatric patients who underwent AVM resection by utilizing CPT and ICD codes. Primary outcomes were a composite of 30-day mortality, complications, unplanned reoperation, and other related metrics. Multivariable logistic regression was performed to assess predictors.
Among 930 pediatric patients analyzed, 34.3% had adverse outcomes in the 30-day postoperative period, with a mortality rate of 0.6%. Emergent surgical intervention was strongly associated with adverse outcomes (OR 8.58). Preoperative ventilator dependence and operative time significantly increased risk. Recognized racial disparities showed that African American/Black patients had a higher risk (OR 1.65) while Hispanic patients had a lower risk (OR 0.73).
The study is limited by its retrospective nature and reliance on existing database codes, which may not capture all clinical nuances or patient complexities.
These findings highlight critical factors impacting postoperative outcomes in pediatric AVM patients, emphasizing the need for targeted preoperative strategies and awareness of racial disparities in surgical outcomes.
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.