Evaluation of Intraoperative Adverse Events and Perioperative Outcomes in Pediatric Neurosurgery

Quality monitoring and improvement are crucial in pediatric neurosurgery for effective risk assessment and surgical preparation. This study evaluates the reliability of the ClassIntra classification for intraoperative complications and its potential for predicting postoperative outcomes in pediatric patients. In this prospective cohort study at a tertiary care center, we analyzed 47 pediatric patients undergoing various neurosurgical procedures. Data were systematically collected throughout the perioperative period, focusing on preoperative characteristics, intraoperative variables, and postoperative recovery metrics. The cohort was categorized using the ClassIntra grading system into three groups: CI 0 (N=24), CI 1 (N=20), and CI ≥ 2 (N=3). The mean age was 7.0 years, with no significant demographic differences across groups. Operative times increased with higher ClassIntra grades (126.6 minutes for CI 0, 227.6 minutes for CI 1, and 260.7 minutes for CI ≥ 2; P=0.01). Patients with major intraoperative adverse events showed higher neurological deterioration (P=0.03) and increased 90-day readmission rates in the CI ≥ 2 group (P < 0.01). Intraoperative complications significantly affect postoperative recovery in pediatric neurosurgery. Longer operative times and worse neurological outcomes correlate with higher ClassIntra ratings, emphasizing the need for improved monitoring and risk-reduction strategies.