Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery

Kasper Amund Henriksen; Gorm von Oettingen; Jane Skjøth-Rasmussen; René Mathiasen; Jon Foss-Skiftesvik

doi:10.1007/s00381-023-05902-7

Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery

Kasper Amund Henriksen, Gorm von Oettingen, Jane Skjøth-Rasmussen, René Mathiasen, Jon Foss-Skiftesvik^*

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

PURPOSE: To assess the performance of the risk-predicting Milan Complexity Scale (MCS) on postoperative morbidity in pediatric neuro-oncological surgery.

METHODS: A retrospective dual-center review of children undergoing primary brain tumor resection in Denmark over a 10-year period. MCS scoring was performed based on preoperative imaging, blinded to individual outcomes. Surgical morbidity was registered according to existing complication scales and dichotomized as significant or nonsignificant morbidity. The MCS was evaluated using logistic regression modeling.

RESULTS: 208 children (50% female, mean age 7.9 y, and SD 5.2) were included. Of the original "Big Five" predictors included in the MCS, only posterior fossa (OR: 2.31, 95% CI: 1.25-4.34, p-value = 0.008) and eloquent area (OR: 3.32, 95% CI: 1.50-7.68, p-value = 0.004) locations were significantly associated with increased risk of significant morbidity in our pediatric cohort. The absolute MCS score correctly classified 63.0% of cases. Its accuracy increased to 69.2% when mutually adjusting for each of the "Big Five" predictors with corresponding positive and negative predictive values of 66.2% and 71.0%, using a predicted probability cutoff of 0.5.

CONCLUSION: The MCS is predictive of postoperative morbidity also in pediatric neuro-oncological surgery, although only two of its original five variables were significantly associated with poor outcome in children. The clinical value of the MCS is likely limited for the experienced pediatric neurosurgeon. Future clinically impactful risk-prediction tools should include a larger number of relevant variables and be tailored to the pediatric population.

Originalsprog	Engelsk
Tidsskrift	Child's Nervous System
Vol/bind	39
Nummer	8
Sider (fra-til)	2087-2093
Antal sider	6
ISSN	0256-7040
DOI	https://doi.org/10.1007/s00381-023-05902-7
Status	Udgivet - aug. 2023
Udgivet eksternt	Ja

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@article{60737f55ff824560be44311a6d5a7332,

title = "Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery",

abstract = "PURPOSE: To assess the performance of the risk-predicting Milan Complexity Scale (MCS) on postoperative morbidity in pediatric neuro-oncological surgery.METHODS: A retrospective dual-center review of children undergoing primary brain tumor resection in Denmark over a 10-year period. MCS scoring was performed based on preoperative imaging, blinded to individual outcomes. Surgical morbidity was registered according to existing complication scales and dichotomized as significant or nonsignificant morbidity. The MCS was evaluated using logistic regression modeling.RESULTS: 208 children (50% female, mean age 7.9 y, and SD 5.2) were included. Of the original {"}Big Five{"} predictors included in the MCS, only posterior fossa (OR: 2.31, 95% CI: 1.25-4.34, p-value = 0.008) and eloquent area (OR: 3.32, 95% CI: 1.50-7.68, p-value = 0.004) locations were significantly associated with increased risk of significant morbidity in our pediatric cohort. The absolute MCS score correctly classified 63.0% of cases. Its accuracy increased to 69.2% when mutually adjusting for each of the {"}Big Five{"} predictors with corresponding positive and negative predictive values of 66.2% and 71.0%, using a predicted probability cutoff of 0.5.CONCLUSION: The MCS is predictive of postoperative morbidity also in pediatric neuro-oncological surgery, although only two of its original five variables were significantly associated with poor outcome in children. The clinical value of the MCS is likely limited for the experienced pediatric neurosurgeon. Future clinically impactful risk-prediction tools should include a larger number of relevant variables and be tailored to the pediatric population.",

keywords = "Pediatric brain tumors, Pediatric neurosurgery, Surgical complications, Surgical morbidity, Surgical outcomes, Predictive Value of Tests, Humans, Logistic Models, Male, Morbidity, Postoperative Complications/epidemiology, Female, Retrospective Studies, Child",

author = "Henriksen, {Kasper Amund} and Oettingen, {Gorm von} and Jane Skj{\o}th-Rasmussen and Ren{\'e} Mathiasen and Jon Foss-Skiftesvik",

note = "{\textcopyright} 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2023",

month = aug,

doi = "10.1007/s00381-023-05902-7",

language = "English",

volume = "39",

pages = "2087--2093",

journal = "Child's Nervous System",

issn = "0256-7040",

publisher = "Springer",

number = "8",

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Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery. / Henriksen, Kasper Amund; Oettingen, Gorm von; Skjøth-Rasmussen, Jane et al.
I: Child's Nervous System, Bind 39, Nr. 8, 08.2023, s. 2087-2093.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery

AU - Henriksen, Kasper Amund

AU - Oettingen, Gorm von

AU - Skjøth-Rasmussen, Jane

AU - Mathiasen, René

AU - Foss-Skiftesvik, Jon

PY - 2023/8

Y1 - 2023/8

N2 - PURPOSE: To assess the performance of the risk-predicting Milan Complexity Scale (MCS) on postoperative morbidity in pediatric neuro-oncological surgery.METHODS: A retrospective dual-center review of children undergoing primary brain tumor resection in Denmark over a 10-year period. MCS scoring was performed based on preoperative imaging, blinded to individual outcomes. Surgical morbidity was registered according to existing complication scales and dichotomized as significant or nonsignificant morbidity. The MCS was evaluated using logistic regression modeling.RESULTS: 208 children (50% female, mean age 7.9 y, and SD 5.2) were included. Of the original "Big Five" predictors included in the MCS, only posterior fossa (OR: 2.31, 95% CI: 1.25-4.34, p-value = 0.008) and eloquent area (OR: 3.32, 95% CI: 1.50-7.68, p-value = 0.004) locations were significantly associated with increased risk of significant morbidity in our pediatric cohort. The absolute MCS score correctly classified 63.0% of cases. Its accuracy increased to 69.2% when mutually adjusting for each of the "Big Five" predictors with corresponding positive and negative predictive values of 66.2% and 71.0%, using a predicted probability cutoff of 0.5.CONCLUSION: The MCS is predictive of postoperative morbidity also in pediatric neuro-oncological surgery, although only two of its original five variables were significantly associated with poor outcome in children. The clinical value of the MCS is likely limited for the experienced pediatric neurosurgeon. Future clinically impactful risk-prediction tools should include a larger number of relevant variables and be tailored to the pediatric population.

AB - PURPOSE: To assess the performance of the risk-predicting Milan Complexity Scale (MCS) on postoperative morbidity in pediatric neuro-oncological surgery.METHODS: A retrospective dual-center review of children undergoing primary brain tumor resection in Denmark over a 10-year period. MCS scoring was performed based on preoperative imaging, blinded to individual outcomes. Surgical morbidity was registered according to existing complication scales and dichotomized as significant or nonsignificant morbidity. The MCS was evaluated using logistic regression modeling.RESULTS: 208 children (50% female, mean age 7.9 y, and SD 5.2) were included. Of the original "Big Five" predictors included in the MCS, only posterior fossa (OR: 2.31, 95% CI: 1.25-4.34, p-value = 0.008) and eloquent area (OR: 3.32, 95% CI: 1.50-7.68, p-value = 0.004) locations were significantly associated with increased risk of significant morbidity in our pediatric cohort. The absolute MCS score correctly classified 63.0% of cases. Its accuracy increased to 69.2% when mutually adjusting for each of the "Big Five" predictors with corresponding positive and negative predictive values of 66.2% and 71.0%, using a predicted probability cutoff of 0.5.CONCLUSION: The MCS is predictive of postoperative morbidity also in pediatric neuro-oncological surgery, although only two of its original five variables were significantly associated with poor outcome in children. The clinical value of the MCS is likely limited for the experienced pediatric neurosurgeon. Future clinically impactful risk-prediction tools should include a larger number of relevant variables and be tailored to the pediatric population.

KW - Pediatric brain tumors

KW - Pediatric neurosurgery

KW - Surgical complications

KW - Surgical morbidity

KW - Surgical outcomes

KW - Predictive Value of Tests

KW - Humans

KW - Logistic Models

KW - Male

KW - Morbidity

KW - Postoperative Complications/epidemiology

KW - Female

KW - Retrospective Studies

KW - Child

UR - http://www.scopus.com/inward/record.url?scp=85149319902&partnerID=8YFLogxK

U2 - 10.1007/s00381-023-05902-7

DO - 10.1007/s00381-023-05902-7

M3 - Journal article

C2 - 36877208

SN - 0256-7040

VL - 39

SP - 2087

EP - 2093

JO - Child's Nervous System

JF - Child's Nervous System

IS - 8

ER -

Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery

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