Insights from a Nationwide Study on Pediatric Posterior Fossa Decompression

A nationwide analysis of 6,910 pediatric posterior fossa decompression cases found children with Chiari-like posterior fossa crowding experienced greater short-term morbidity and higher early reoperation rates.

In a national pediatric surgical registry covering 2012-2021, investigators identified 6,910 posterior fossa decompression procedures with a 30-day outcome window; 752 patients (11%) were classified as syndromic. The syndromic group was younger (mean 7.08 vs. 9.75 years), carried a higher comorbidity burden, and had a longer mean length of stay, defining a higher-risk baseline profile for comparison.

Unadjusted outcomes highlighted higher absolute event rates in the syndromic cohort: any 30-day complication 12.0% versus 8.7%, 30-day readmission 9.4% versus 7.1%, and 30-day reoperation 6.6% versus 2.9%—the latter more than a twofold relative increase. Mean hospital stay was longer for syndromic patients (5.17 vs. 3.64 days), underscoring greater early morbidity and resource use before risk adjustment.

After multivariable adjustment using the national pediatric surgical database, syndromic status remained an independent predictor of 30-day reoperation (OR 1.51; 95% CI 1.03–2.19; p=0.032) but was not independently associated with overall 30-day complications (OR 0.94; 95% CI 0.71–1.23; p=0.66) or 30-day readmission (OR 0.96; 95% CI 0.71–1.29; p=0.80). This pattern suggests baseline differences in age, ASA class, and comorbidity burden largely explain the excess unadjusted complications and readmissions; syndromic status appears to track independently with early reoperation risk.

Longer-term neurologic outcomes were not assessable within the registry beyond 30 days, and the syndromic cohort’s heterogeneity and coding limits restrict syndrome-specific inference. Mortality within 30 days remained low in both groups. Prospective follow-up emphasizing wound- and CSF-related complications, evolving hydrocephalus, and functional recovery metrics beyond the immediate postoperative window will be needed to define durable neurologic benefit and late complications.