Resident Division of Neurosurgery, University of Ottawa Markham, Canada
Introduction: Pediatric brain tumors can be associated with significant morbidity. Although short-term outcomes have been evaluated following acute postoperative hyponatremia in children with intracranial tumours, longer- term consequences have yet to be assessed. This study will assess the impact of postoperative hyponatremia on mortality and morbidity in pediatric brain tumour patients during admission and following discharge.
Methods: This is a retrospective cohort study of children less than 18 years at initial presentation who underwent resection of a primary brain tumour between 2001-2019 at a quaternary university children’s hospital. Those who underwent radiotherapy or chemotherapy were excluded. Hyponatremia was defined as serum sodium ≤ 134 mEq/L during postoperative admission, and severe hyponatremia as ≤ 129 mEq/L. Patient charting was reviewed at the 6-month and 2-year follow-up to assess mortality and morbidity outcomes including neurological dysfunction, electrolyte disturbances, endocrinological disorders, Functional Status Scale (FSS) and hospital Length of Stay (LOS).
Results: Of 70 patients, postoperative hyponatremia occurred in 16 (23%), of which three were severe (4.3%). Extended hospital LOS was seen in hyponatremic patients with a median of 7 (range: 2-37) days compared to 3 (1-26) days for normonatremic patients (p = 0.02). No statistically significant difference was found in the immediate postoperative status between the hyponatremic or normonatremic populations. Both populations had largely equivalent morbidity and FSS over the course of 2-year follow-up.
Conclusion : This study is an exploratory analysis of the immediate and long-term course of patients with postoperative hyponatremia following tumour biopsy or resection. These results demonstrate that hyponatremia may be associated with prolonged hospital stay in this population. Further research should include a larger sample size to assess potential perioperative preventative strategies which could potentially conserve healthcare resources and limit the psychological burden on children of an extended hospital stay.
