Incidence and risk factors for postoperative pulmonary complications in children following surgery for retroperitoneal neuroblastoma.

Introduction: Neuroblastoma is a common extracranial solid tumor in children, associated with high perioperative risk. Postoperative pulmonary complications, such as pneumonia and pleural effusion, occur frequently and may adversely affect patient prognosis. However, the underlying risk factors remain incompletely understood. This study aimed to investigate risk factors for pulmonary complications following neuroblastoma resection and to establish predictive cutoff values for clinical risk stratification. Methods: This single-center retrospective study included 214 children who underwent elective abdominal neuroblastoma resection between April 2018 and December 2020. The primary endpoint was the incidence of postoperative pulmonary complications. Preoperative, intraoperative, and postoperative variables were analyzed using univariate and multivariate logistic regression. Receiver operating characteristic analysis was performed to determine cutoff values for clinical parameters. Results: The incidence of postoperative pulmonary complications was 26.2%. Logistic regression analysis identified three independent risk factors: postoperative day 1 albumin concentration (cutoff: 32.9 g·L⁻ Conclusion: This study identifies critical thresholds for identifying children at high risk of pulmonary complications after neuroblastoma resection, facilitating more accurate risk stratification and early intervention. These findings have important clinical implications for optimizing perioperative management and reducing postoperative morbidity.