What database can I use to track intracranial pressures, electrolyte imbalances (including sodium and chloride levels), mortality, and bleeding complications requiring transfusions in pediatric patients (under 18 years old) undergoing craniotomy surgeries?

Database Resources for Pediatric Craniotomy Outcomes

The National Surgical Quality Improvement Program (NSQIP) Pediatric database is the most appropriate resource for tracking intracranial pressures, electrolyte imbalances (sodium and chloride), mortality, and bleeding complications requiring transfusions in pediatric patients undergoing craniotomy surgeries.

Primary Database Recommendation

NSQIP Pediatric Database provides comprehensive 30-day perioperative outcome data specifically for pediatric surgical patients, including craniotomy procedures 1. This database captures:

• Mortality rates (30-day postoperative mortality) 1
• Bleeding complications requiring transfusion 1
• Reoperation rates within 30 days 1
• Readmission rates within 30 days 1
• Systemic complications including renal insufficiency (which affects electrolyte management) 1
• Neurological outcomes including stroke 1

The NSQIP-P database has been successfully used to analyze outcomes in 167 pediatric patients undergoing craniotomy for arteriovenous malformations, demonstrating its utility for tracking the specific outcomes you need 1.

Key Variables Available in NSQIP-P

Mortality and Major Complications

• 30-day mortality is tracked as a primary outcome 1
• Unplanned reoperation within 30 days (which would capture bleeding requiring surgical intervention) occurs in approximately 10% of pediatric craniotomy patients 1
• Unplanned readmission within 30 days occurs in approximately 12% of cases 1

Bleeding-Related Outcomes

• Perioperative blood transfusion requirements are documented 2
• Major bleeding is defined as bleeding requiring surgical intervention in an operating suite, interventional radiology, or endoscopy 2
• Intracranial hemorrhage rates can be tracked, with baseline rates of 0.4% for intracerebral hemorrhage and 1.1% for chronic subdural hematoma in pediatric craniotomy patients 3

Electrolyte Monitoring Considerations

While NSQIP-P may have limited granular electrolyte data, hyponatremia is a critical postoperative complication in pediatric craniotomy patients that you should track 4. Sodium levels as low as 128-133 mEq/L have been documented postoperatively, often due to cerebral salt wasting syndrome rather than SIADH 4. This requires:

• Daily serum sodium and chloride measurements through postoperative day 4 4
• Urine sodium and osmolarity measurements 4
• Monitoring for increased urine output (>1 cc/kg/h) which suggests cerebral salt wasting 4

Intracranial Pressure Monitoring

ICP monitoring should be placed or continued after craniotomy if any of these criteria are present 5, 6:

• Preoperative Glasgow motor response ≤5 6
• Preoperative anisocoria or bilateral mydriasis 6
• Preoperative hemodynamic instability 6
• Intraoperative cerebral edema 6
• Postoperative appearance of new intracranial lesions on imaging 6

Target ICP should be maintained below 20-25 mmHg, with cerebral perfusion pressure (CPP) maintained between 60-70 mmHg 5, 7, 6.

Alternative Database Options

Society of Thoracic Surgeons (STS) Database

The STS Congenital Heart Surgery database has been linked with the Pediatric Health Information database for tracking bleeding complications and transfusion requirements in pediatric surgical patients 2. While this is cardiac-focused, the methodology could be adapted for neurosurgical tracking.

Institutional Prospective Databases

Single-institution prospectively collected databases have successfully tracked comprehensive outcomes in pediatric craniotomy patients 3, 8. A Norwegian series of 273 consecutive craniotomies demonstrated:

• Surgical mortality of 0.4% within 30 days 3
• Meningitis rate of 1.8% 3
• Cerebral infarction rate of 1.5% 3
• CSF leak rate of 7.3% 3
• New neurological deficits in 12.4% of patients (9.5% minor/moderate, 2.9% severe) 3

Critical Pitfalls to Avoid

Do not rely solely on blood pressure measurements to assess adequate cerebral perfusion, as "normal" blood pressure may be inadequate if hypoperfusion goes unrecognized 5. Mean arterial pressure must be measured at the level of the external ear canal (tragus/foramen of Monro) to avoid overestimating CPP 5, 7.

Do not assume all postoperative hyponatremia is SIADH and treat with fluid restriction 4. Cerebral salt wasting syndrome is common after pediatric craniotomy and requires normal saline resuscitation, not fluid restriction 4. The key distinguishing features are increased urine output, increased urine sodium, and volume contraction 4.

Perioperative hypertension significantly increases ICH risk 9. Sixty-two percent of patients who developed postoperative ICH had intraoperative hypertension (BP ≥160/90 mmHg), compared to only 34% of controls, with an odds ratio of 4.6 for postoperative ICH 9. Hospital stay is severely prolonged (median 24.5 vs 11.0 days) and mortality is dramatically higher (18.2% vs 1.6%) in patients who develop postcraniotomy ICH 9.