Acta Neurochirurgica

, Volume 159, Issue 6, pp 975–979

Does scope of practice correlate with the outcomes of craniotomy for tumor resection in children?

Original Article - Pediatrics

DOI: 10.1007/s00701-017-3160-x

Cite this article as:
Missios, S. & Bekelis, K. Acta Neurochir (2017) 159: 975. doi:10.1007/s00701-017-3160-x



The relationship of scope of practice (predominantly adult, versus predominantly pediatric) with the outcomes of brain tumor surgery in children remains uncertain. We investigated the association of practice focus with the outcomes of neurosurgical oncology operations in pediatric patients.


We performed a cohort study of all pediatric patients (younger than 18 years old) who underwent craniotomies for tumor resections from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. In order to control for confounding, we used propensity score conditioning with mixed effects analysis to account for clustering at the hospital level.


During the study period, there were 770 pediatric patients who underwent craniotomy for tumor resection and met the inclusion criteria. Of these, 370 (48.1%) underwent treatment by providers with predominantly adult practices and 400 (51.9%) by physicians who operated predominantly on children. Mixed-effects multivariable regression analysis demonstrated lack of association of predominantly adult practice with inpatient mortality (OR, 1.12; 95% CI, 0.48–2.58), and discharge to a facility (OR, 1.25; 95% CI, 0.77–2.03). These associations persisted in propensity-adjusted models.


In a cohort of pediatric patients undergoing craniotomy for tumor resection from a comprehensive all-payer database, we did not demonstrate a difference in mortality, and discharge to a facility between providers with predominantly adult and predominantly pediatric practices.


Craniotomy for tumor resection Pediatrics Scope of practice SPARCS 

Supplementary material

701_2017_3160_MOESM1_ESM.doc (40 kb)
ESM 1(DOC 40 kb)

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.Department of Neurosurgery, CNS Healthcare FoundationAkron General Hospital-Cleveland ClinicAkronUSA
  2. 2.Department of NeurosurgeryThomas Jefferson University HospitalPhiladelphiaUSA
  3. 3.The Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  4. 4.Section of NeurosurgeryDartmouth-Hitchcock Medical CenterLebanonUSA

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