Postoperative Complications in Pediatric Brain Tumor Surgery in Latin America: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract Pediatric brain tumors are one of the most common causes of cancer-related death in children. Surgical resection is the primary treatment of choice; however, postoperative complications can impact outcomes, particularly in low- and middle-income countries. The current systematic review and meta-analysis estimated the burden and evaluated the risk factors related to the postoperative complications of pediatric brain tumor surgery in Latin America, and compared the outcomes to those of European cohorts. Following the 2020 Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (PROSPERO ID: CRD420251124110), we conducted searches on the PubMed, Scopus, Web of Science, Embase, SciELO, and LILACS databases for studies published f from inception until June 30, 2025 on the postoperative complications of patients aged ≤ 18 years undergoing brain tumor resection in Latin America. The studies included had to have a sample size ≥ 30 individuals and report at least one of the following outcomes: surgical site infection, hemorrhage, new neurological deficit, or mortality. The secondary outcomes included altered sodium levels after surgery. Pooled data were analyzed using DerSimonian-Laird random-effects models, and indirect comparisons were made with contemporary studies from Europe and the United States. A total of 26 studies (from 10 countries and including 3,472 patients) met the inclusion criteria, and 21 were included in the current meta-analysis. The pooled complication rates were as follows: infection – 12.8% (95%CI: 10.1–15.7%); hemorrhage – 6.4% (95%CI:4.5–8.6%); neurological deficits – 18.5% 95%CI: 14.7–22.6%; and 30-day mortality – 4.2% (95%CI: 2.8–5.8%). Alterations in sodium levels were noted in 7.6% (95%CI: 5.0–10.5%) due to hyponatremia, and in 4.3% (95%CI: 2.5–6.5%) due hypernatremia, often in the context of posterior fossa and suprasellar tumors. Regarding regional benchmarks, the lowest complication rates in Latin America were found in Uruguay, and the highest, in Bolivia, Venezuela, and Honduras (risk ratio [RR] of up to 2.25). The risk factors included: age < 3 years, tumor size > 5cm, operative time > 5 hours, and limited access to pediatric intensive care in countries with few specialized pediatric surgical centers. The postoperative infection and mortality rates following pediatric brain tumor surgery are significantly higher in Latin America than in Europe and the United States; this reflects disparities in the perioperative infrastructure and in the ability to deliver specialized care. Strengthen infection control, facilitate access to pediatric intensive care, and the standardization of sodium monitoring protocols should be priorities to improve the outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.032 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".