Impact of social factors on outcomes following pediatric neuro-oncology surgery in the United States: a systematic review and meta-analysis.

Abstract

To use AI-assisted software to identify gender, racial, and socioeconomic differences in post-operative outcomes following pediatric neuro-oncology surgery. PubMed, Scopus, Web of Science, and Ovid were queried using a semi-automated software. Meta-analyses quantified pooled odds ratios for overall survival (OS), gross total resection (GTR), recurrence, 30-day readmission, medical complications (neurologic and endocrinologic), and surgical complications. Where possible, subanalyses were performed based on study type and cranial tumor location. Sixty-seven studies were included. Across all studies, white children had greater OS (OR 0.70, 95% CI [0.55, 0.88]) and GTR (OR 0.86, 95% CI [0.78, 0.93]), while non-white children more often had a medical complication (OR 1.33, 95% CI [1.01, 1.76]). Those with government insurance (OR 1.72, 95% CI [1.01, 2.92]) or lower household income (OR 1.25, 95% CI [1.10, 1.42]) had higher 30-day readmission rates. Patients treated at a small-volume facility had lower rates (OR 0.80, 95% CI [0.71, 0.91]). Subanalyses of case series showed female patients were at higher risk of endocrinologic complications (OR 2.56, 95% CI [1.17, 5.64]), namely hypopituitarism (OR 3.29, 95% CI [1.10, 9.86]). In cohort studies, female patients more often experienced diabetes insipidus (OR 2.22, 95% CI [1.20, 4.08]). Non-white, government-insured, lower-income, and female patients are more likely to experience an adverse event. This study identifies the importance of considering demographic variables during pre-operative risk assessment. Our findings warrant further subgroup analyses across varying tumor locations and types to elucidate parameters contributing to these disparities and explore interventions.