The effect of centralized care on the management of postoperative fluctuations in plasma sodium concentration after pediatric suprasellar brain tumor surgery

PURPOSE: Children undergoing neurosurgery for (supra)sellar tumors are at risk of developing arginine vasopressin-deficiency (AVP-D), which can cause severe sodium fluctuations and associated neurological complications, prolonged hospitalization and mortality. A previous Dutch study reported sodium shifts ≥ 10 mmol/L/24 h in 75.3% of patients with early postoperative AVP-D, with a maximum delta of 46 mmol/L/24 h. Since 2018, pediatric oncology care has been centralized in the Netherlands. We evaluated the impact of this centralization on postoperative sodium fluctuations in children with (supra)sellar tumors. METHODS: Data from all children who underwent neurosurgery for a (supra)sellar tumor at the Princess Máxima Centrum (Utrecht, the Netherlands) between January 2018 and December 2023 were retrospectively collected from electronic health records, including presence of preoperative AVP-D, plasma sodium concentrations during the first 10 postoperative days, administration of desmopressin, and short- and long-term neurological symptoms. Results were additionally interpreted in the context of pre-centralization data. RESULTS: Among 73 patients with a median age of 7.9 years (range 0-17.5) at tumor resection, postoperative AVP-D occurred in 69.7%. During the first 10 postoperative days, sodium fluctuations ≥ 10 mmol/L/24 h were seen in 49.1% of these patients, with a maximum delta of 30 mmol/L/24 h. Since 2018, sodium fluctuations diminished, with a maximum delta plasma sodium of 14 mmol/L/24 h in 2023. No association was found between early postoperative AVP-D and occurrence of neurological symptoms. CONCLUSION: Trends observed after centralization of care for children with (supra)sellar tumors may suggest improved postoperative AVP-D management, resulting in less frequent and less severe fluctuations in plasma sodium concentrations.