{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:32:39Z","timestamp":1786541559950,"version":"build-2736575974"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Patient demographic characteristics, hospital volume, and admission status have been shown to impact surgical outcomes of sellar region tumors in adults; however, the data available following the resection of craniopharyngiomas in the pediatric population remain limited. The authors sought to identify potential risk factors associated with outcomes following surgical management of pediatric craniopharyngiomas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Nationwide Inpatient Sample database and Kids' Inpatient Database were analyzed to include admissions for pediatric patients (\u2264 18 years) who underwent a transcranial or transsphenoidal craniotomy for resection of a craniopharyngioma. Patient-level factors, including age, race, comorbidities, and insurance type, as well as hospital factors were collected. Outcomes analyzed included mortality rate, endocrine and nonendocrine complications, hospital charges, and length of stay. A multivariate model controlling for variables analyzed was constructed to examine significant independent risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Between 2000 and 2011, 1961 pediatric patients were identified who underwent a transcranial (71.2%) or a transsphenoidal (28.8%) craniotomy for resection of a craniopharyngioma. A major predilection for age was observed with the selection of a transcranial (23.4% in &lt; 7-year-olds, 28.1% in 7- to 12-year-olds, and 19.7% in 13- to 18-year-olds) versus transphenoidal (2.9% in &lt; 7-year-olds, 7.4% in 7- to 12-year-olds, and 18.4% in 13- to 18-year-olds) approach. No significant outcomes were associated with a particular surgical approach, except that 7- to 12-year-old patients had a higher risk of nonendocrine complications (relative risk [RR] 2.42, 95% CI 1.04\u20135.65, p = 0.04) with the transsphenoidal approach when compared with 13- to 18-year-old patients. The overall inpatient mortality rate was 0.5% and the most common postoperative complication was diabetes insipidus (64.2%). There were no independent factors associated with inpatient mortality rates and no significant differences in outcomes among groups based on sex and race. The average length of stay was 11.8 days, and the mean hospital charge was $116,5 22. Hospitals with medium and large bed capacity were protective against nonendocrine complications (RR 0.53, 95% CI 0.3\u20130.93, p = 0.03 [medium]; RR 0.45, 95% CI 0.25\u20130.8, p &lt; 0.01 [large]) and total complications (RR 0.73, 95% CI 0.55\u20130.97, p = 0.03 [medium]; RR 0.68, 95% CI 0.51\u20130.9, p &lt; 0.01 [large]) when compared with hospitals with small bed capacity (&lt; 200 beds). Patients admitted to rural hospitals had an increased risk for nonendocrine complications (RR 2.56, 95% CI 1.11\u20135.9, p = 0.03). The presence of one or more medical comorbidities increased the risk of higher total complications (RR 1.38, 95% CI 1.14\u20131.68), p &lt; 0.01 [1 comorbidity]; RR 2.37, 95% CI 1.98\u20132.84, p &lt; 0.01 [\u2265 2 comorbidities]) and higher total hospital charges (RR 2.9, 95% CI 1.08\u20137.81, p = 0.04 [1 comorbidity]; RR 9.1, 95% CI 3.74\u201322.12, p &lt; 0.01 [\u2265 2 comorbidities]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This analysis identified patient age, comorbidities, insurance type, hospital bed capacity, and rural or nonteaching hospital status as independent risk factors for postoperative complications and\/or increased hospital charges in pediatric patients with craniopharyngioma. Transsphenoidal surgery in younger patients with craniopharyngioma was a risk factor for nonendocrine complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2016.8.focus16268","type":"journal-article","created":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T03:37:19Z","timestamp":1480563439000},"page":"E8","source":"Crossref","is-referenced-by-count":36,"title":["Risk factors associated with the surgical management of craniopharyngiomas in pediatric patients: analysis of 1961 patients from a national registry database"],"prefix":"10.3171","volume":"41","author":[{"given":"Joshua","family":"Bakhsheshian","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana L.","family":"Jin","sequence":"additional","affiliation":[{"name":"Keck School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Eun","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben A.","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan A.","family":"Donoho","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Cen","sequence":"additional","affiliation":[{"name":"Department of Neurology; and"},{"name":"Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Attenello","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisha A.","family":"Christian","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16268","series-title":"ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification Volumes 1 and 2","author":"American Medical Association","year":"2006"},{"key":"b2-focus16268","series-title":"J Clin Endocrinol Metab","first-page":"4709","article-title":"Transsphenoidal surgery for pituitary tumors in the United States, 1996\u20132000 mortality, morbidity, and the effects of hospital and surgeon volume","volume":"88","author":"Barker","year":"2003"},{"key":"b3-focus16268","series-title":"J Neurosurg","first-page":"547","article-title":"The descriptive epidemiology of craniopharyngioma","volume":"89","author":"Bunin","year":"1998"},{"key":"b4-focus16268","series-title":"J Public Health (Oxf)","first-page":"138","article-title":"Systematic review of discharge coding accuracy","volume":"34","author":"Burns","year":"2012"},{"key":"b5-focus16268","series-title":"Neuro Oncol","first-page":"767","article-title":"Trends in treatment and outcomes of pediatric craniopharyngioma, 1975\u20132011","volume":"15","author":"Cohen","year":"2013"},{"key":"b6-focus16268","series-title":"Neurosurgery","first-page":"48","article-title":"The impact of provider volume on mortality after intracranial tumor resection","volume":"52","author":"Cowan","year":"2003"},{"key":"b7-focus16268","series-title":"J Clin Endocrinol Metab","first-page":"5435","article-title":"Changes in height, weight, and body mass index in children with craniopharyngioma after three years of growth hormone therapy: analysis of KIGS (Pfizer International Growth Database)","volume":"89","author":"Geffner","year":"2004"},{"issue":"6","key":"b8-focus16268","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Improving discharge data fidelity for use in large administrative databases","volume":"36","author":"Gologorsky","year":"2014"},{"key":"b9-focus16268","series-title":"Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001","author":"Houchens","year":"2005"},{"key":"b10-focus16268","series-title":"Neurosurgery","first-page":"286","article-title":"Persistent outpatient hyperglycemia is independently associated with decreased survival after primary resection of malignant brain astrocytomas","volume":"63","author":"McGirt","year":"2008"},{"key":"b11-focus16268","series-title":"J Clin Endocrinol Metab","first-page":"1981","article-title":"Consequences of craniopharyngioma surgery in children","volume":"96","author":"M\u00fcller","year":"2011"},{"key":"b12-focus16268","series-title":"J Neurooncol","first-page":"9","article-title":"A systematic review of cognitive performance in patients with childhood craniopharyngioma","volume":"125","author":"\u00d6zyurt","year":"2015"},{"issue":"1 Suppl","key":"b13-focus16268","series-title":"J Neurosurg","first-page":"3","article-title":"Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement","volume":"106","author":"Puget","year":"2007"},{"key":"b14-focus16268","series-title":"J Neurosurg","first-page":"736","article-title":"Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011","volume":"120","author":"Rolston","year":"2014"},{"key":"b15-focus16268","series-title":"Cancer","first-page":"1279","article-title":"Insurance status and risk of cancer mortality among adolescents and young adults","volume":"121","author":"Rosenberg","year":"2015"},{"key":"b16-focus16268","series-title":"Pediatr Neurol","first-page":"4","article-title":"A review of childhood and adolescent craniopharyngiomas with particular attention to hypothalamic obesity","volume":"50","author":"Rosenfeld","year":"2014"},{"issue":"4 Suppl","key":"b17-focus16268","series-title":"J Neurosurg","first-page":"302","article-title":"Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma","volume":"103","author":"Sands","year":"2005"},{"issue":"Suppl 1","key":"b18-focus16268","series-title":"Pediatr Neurosurg","first-page":"39","article-title":"Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery","volume":"21","author":"Sanford","year":"1994"},{"key":"b19-focus16268","series-title":"J Neurosurg Spine","first-page":"125","article-title":"Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003\u20132010","volume":"20","author":"Sharma","year":"2014"},{"key":"b20-focus16268","series-title":"Neurosurgery","first-page":"553","article-title":"Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care","volume":"54","author":"Smith","year":"2004"},{"key":"b21-focus16268","series-title":"J Neurooncol","first-page":"463","article-title":"Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma","volume":"101","author":"Sughrue","year":"2011"},{"key":"b22-focus16268","series-title":"Laryngoscope","first-page":"1730","article-title":"Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients","volume":"120","author":"Tatreau","year":"2010"},{"key":"b23-focus16268","series-title":"Clin Neurol Neurosurg","first-page":"102","article-title":"Sellar and parasellar lesions\u2014clinical outcome in 61 children","volume":"123","author":"Unsinn","year":"2014"},{"key":"b24-focus16268","series-title":"Laryngoscope","first-page":"1307","article-title":"Current trends in surgical approach and outcomes following pituitary tumor resection","volume":"125","author":"Villwock","year":"2015"},{"key":"b25-focus16268","series-title":"J Neurooncol","first-page":"105","article-title":"Late mortality in pediatric patients with craniopharyngioma","volume":"100","author":"Visser","year":"2010"},{"issue":"2","key":"b26-focus16268","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Demographic factors, outcomes, and patient access to transsphenoidal surgery for Cushing's disease: analysis of the Nationwide Inpatient Sample from 2002 to 2010","volume":"38","author":"Wilson","year":"2015"},{"key":"b27-focus16268","series-title":"Neurosurgery","first-page":"99","article-title":"Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors","volume":"61","author":"Woodworth","year":"2007"},{"key":"b28-focus16268","series-title":"Horm Res Paediatr","first-page":"62","article-title":"Surgical management of craniopharyngiomas in the pediatric population","volume":"74","author":"Zada","year":"2010"},{"issue":"5","key":"b29-focus16268","series-title":"Neurosurg Focus","first-page":"E6","article-title":"National treatment trends, complications, and predictors of in-hospital charges for the surgical management of craniopharyngiomas in adults from 2007 to 2011","volume":"37","author":"Zaidi","year":"2014"},{"key":"b30-focus16268","series-title":"J Clin Neurosci","first-page":"1558","article-title":"Modern treatment of 84 newly diagnosed craniopharyngiomas","volume":"21","author":"Zygourakis","year":"2014"},{"key":"b1-focus16268","series-title":"ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification Volumes 1 and 2","author":"American Medical Association","year":"2006"},{"key":"b2-focus16268","series-title":"J Clin Endocrinol Metab","first-page":"4709","article-title":"Transsphenoidal surgery for pituitary tumors in the United States, 1996\u20132000 mortality, morbidity, and the effects of hospital and surgeon volume","volume":"88","author":"Barker","year":"2003"},{"key":"b3-focus16268","series-title":"J Neurosurg","first-page":"547","article-title":"The descriptive epidemiology of craniopharyngioma","volume":"89","author":"Bunin","year":"1998"},{"key":"b4-focus16268","series-title":"J Public Health (Oxf)","first-page":"138","article-title":"Systematic review of discharge coding accuracy","volume":"34","author":"Burns","year":"2012"},{"key":"b5-focus16268","series-title":"Neuro Oncol","first-page":"767","article-title":"Trends in treatment and outcomes of pediatric craniopharyngioma, 1975\u20132011","volume":"15","author":"Cohen","year":"2013"},{"key":"b6-focus16268","series-title":"Neurosurgery","first-page":"48","article-title":"The impact of provider volume on mortality after intracranial tumor resection","volume":"52","author":"Cowan","year":"2003"},{"key":"b7-focus16268","series-title":"J Clin Endocrinol Metab","first-page":"5435","article-title":"Changes in height, weight, and body mass index in children with craniopharyngioma after three years of growth hormone therapy: analysis of KIGS (Pfizer International Growth Database)","volume":"89","author":"Geffner","year":"2004"},{"issue":"6","key":"b8-focus16268","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Improving discharge data fidelity for use in large administrative databases","volume":"36","author":"Gologorsky","year":"2014"},{"key":"b9-focus16268","series-title":"Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001","author":"Houchens","year":"2005"},{"key":"b10-focus16268","series-title":"Neurosurgery","first-page":"286","article-title":"Persistent outpatient hyperglycemia is independently associated with decreased survival after primary resection of malignant brain astrocytomas","volume":"63","author":"McGirt","year":"2008"},{"key":"b11-focus16268","series-title":"J Clin Endocrinol Metab","first-page":"1981","article-title":"Consequences of craniopharyngioma surgery in children","volume":"96","author":"M\u00fcller","year":"2011"},{"key":"b12-focus16268","series-title":"J Neurooncol","first-page":"9","article-title":"A systematic review of cognitive performance in patients with childhood craniopharyngioma","volume":"125","author":"\u00d6zyurt","year":"2015"},{"issue":"1 Suppl","key":"b13-focus16268","series-title":"J Neurosurg","first-page":"3","article-title":"Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement","volume":"106","author":"Puget","year":"2007"},{"key":"b14-focus16268","series-title":"J Neurosurg","first-page":"736","article-title":"Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011","volume":"120","author":"Rolston","year":"2014"},{"key":"b15-focus16268","series-title":"Cancer","first-page":"1279","article-title":"Insurance status and risk of cancer mortality among adolescents and young adults","volume":"121","author":"Rosenberg","year":"2015"},{"key":"b16-focus16268","series-title":"Pediatr Neurol","first-page":"4","article-title":"A review of childhood and adolescent craniopharyngiomas with particular attention to hypothalamic obesity","volume":"50","author":"Rosenfeld","year":"2014"},{"issue":"4 Suppl","key":"b17-focus16268","series-title":"J Neurosurg","first-page":"302","article-title":"Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma","volume":"103","author":"Sands","year":"2005"},{"issue":"Suppl 1","key":"b18-focus16268","series-title":"Pediatr Neurosurg","first-page":"39","article-title":"Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery","volume":"21","author":"Sanford","year":"1994"},{"key":"b19-focus16268","series-title":"J Neurosurg Spine","first-page":"125","article-title":"Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003\u20132010","volume":"20","author":"Sharma","year":"2014"},{"key":"b20-focus16268","series-title":"Neurosurgery","first-page":"553","article-title":"Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care","volume":"54","author":"Smith","year":"2004"},{"key":"b21-focus16268","series-title":"J Neurooncol","first-page":"463","article-title":"Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma","volume":"101","author":"Sughrue","year":"2011"},{"key":"b22-focus16268","series-title":"Laryngoscope","first-page":"1730","article-title":"Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients","volume":"120","author":"Tatreau","year":"2010"},{"key":"b23-focus16268","series-title":"Clin Neurol Neurosurg","first-page":"102","article-title":"Sellar and parasellar lesions\u2014clinical outcome in 61 children","volume":"123","author":"Unsinn","year":"2014"},{"key":"b24-focus16268","series-title":"Laryngoscope","first-page":"1307","article-title":"Current trends in surgical approach and outcomes following pituitary tumor resection","volume":"125","author":"Villwock","year":"2015"},{"key":"b25-focus16268","series-title":"J Neurooncol","first-page":"105","article-title":"Late mortality in pediatric patients with craniopharyngioma","volume":"100","author":"Visser","year":"2010"},{"issue":"2","key":"b26-focus16268","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Demographic factors, outcomes, and patient access to transsphenoidal surgery for Cushing's disease: analysis of the Nationwide Inpatient Sample from 2002 to 2010","volume":"38","author":"Wilson","year":"2015"},{"key":"b27-focus16268","series-title":"Neurosurgery","first-page":"99","article-title":"Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors","volume":"61","author":"Woodworth","year":"2007"},{"key":"b28-focus16268","series-title":"Horm Res Paediatr","first-page":"62","article-title":"Surgical management of craniopharyngiomas in the pediatric population","volume":"74","author":"Zada","year":"2010"},{"issue":"5","key":"b29-focus16268","series-title":"Neurosurg Focus","first-page":"E6","article-title":"National treatment trends, complications, and predictors of in-hospital charges for the surgical management of craniopharyngiomas in adults from 2007 to 2011","volume":"37","author":"Zaidi","year":"2014"},{"key":"b30-focus16268","series-title":"J Clin Neurosci","first-page":"1558","article-title":"Modern treatment of 84 newly diagnosed craniopharyngiomas","volume":"21","author":"Zygourakis","year":"2014"}],"container-title":["Neurosurgical 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