The effect of centralized care on the management of postoperative fluctuations in plasma sodium concentration after pediatric suprasellar brain tumor surgery

Purpose
Children undergoing neurosurgery for (supra)sellar tumors are at risk of developing arginine vasopressin-deficiency (AVP-D), which can cause severe sodium fluctuations and associated neurological complications, prolonged hospitalization and mortality. A previous Dutch study reported sodium shifts ≥ 10 mmol/L/24 h in 75.3% of patients with early postoperative AVP-D, with a maximum delta of 46 mmol/L/24 h. Since 2018, pediatric oncology care has been centralized in the Netherlands. We evaluated the impact of this centralization on postoperative sodium fluctuations in children with (supra)sellar tumors.

Methods
Data from all children who underwent neurosurgery for a (supra)sellar tumor at the Princess Máxima Centrum (Utrecht, the Netherlands) between January 2018 and December 2023 were retrospectively collected from electronic health records, including presence of preoperative AVP-D, plasma sodium concentrations during the first 10 postoperative days, administration of desmopressin, and short- and long-term neurological symptoms. Results were additionally interpreted in the context of pre-centralization data.

Results
Among 73 patients with a median age of 7.9 years (range 0-17.5) at tumor resection, postoperative AVP-D occurred in 69.7%. During the first 10 postoperative days, sodium fluctuations ≥ 10 mmol/L/24 h were seen in 49.1% of these patients, with a maximum delta of 30 mmol/L/24 h. Since 2018, sodium fluctuations diminished, with a maximum delta plasma sodium of 14 mmol/L/24 h in 2023. No association was found between early postoperative AVP-D and occurrence of neurological symptoms.

Conclusion
Trends observed after centralization of care for children with (supra)sellar tumors may suggest improved postoperative AVP-D management, resulting in less frequent and less severe fluctuations in plasma sodium concentrations.