OBJECTIVE: Policies of regionalization and selective referral for a number of "high-risk" surgical procedures are being explored and implemented as a result of significant variation in postoperative mortality between high- and low-volume providers. The effect of provider volume on outcomes after intracranial tumor resection is unknown and warrants investigation. METHODS: By use of the Nationwide Inpatient Sample for 1996 and 1997, patients (older than 19 yr) who had a diagnosis of a malignant central nervous system neoplasm and underwent craniotomy or craniectomy were included. Hospital volume and surgeon volume were categorized by quartiles (very low, low, high, or very high volume). Unadjusted and case mix-adjusted analyses were performed with regard to postoperative in-hospital mortality. RESULTS: The crude in-hospital mortality was 2.8% for a total of 7547 patients. The mean patient age was 55.8 years (66.5% <65; 33.5% >/=65). Mortality for very low- to very high-volume hospitals was as follows: 3.8, 3.2, 2.4, and 1.8% (P < 0.001). Mortality for very low- to very high-volume surgeons was as follows: 4.1, 3.9, 3.1, and 1.4% (P = 0.003). Predictors of mortality in a logistic regression model were emergent admission (odds ratio [OR], 2.97; 95% confidence interval [CI], 2.02-4.38; P < 0.001), and age 65 years or greater (OR, 1.63; 95% CI, 1.16-2.30; P = 0.005). The risk of mortality was reduced for very high-volume hospitals (OR, 0.58; 95% CI, 0.35-0.97; P = 0.038) and very high-volume surgeons (OR, 0.42; 95% CI, 0.22-0.84; P = 0.012). CONCLUSION: Higher-volume providers have superior outcomes after surgical resection of malignant intracranial tumors. This reduction was maintained despite adjustment for case mix. As the regionalization of high-risk surgery moves forward, it is important for neurosurgeons to maintain leadership roles in the development of specialty-specific data collection and health policy initiatives that improve and reduce variation in outcomes.
OBJECTIVE: Policies of regionalization and selective referral for a number of "high-risk" surgical procedures are being explored and implemented as a result of significant variation in postoperative mortality between high- and low-volume providers. The effect of provider volume on outcomes after intracranial tumor resection is unknown and warrants investigation. METHODS: By use of the Nationwide Inpatient Sample for 1996 and 1997, patients (older than 19 yr) who had a diagnosis of a malignant central nervous system neoplasm and underwent craniotomy or craniectomy were included. Hospital volume and surgeon volume were categorized by quartiles (very low, low, high, or very high volume). Unadjusted and case mix-adjusted analyses were performed with regard to postoperative in-hospital mortality. RESULTS: The crude in-hospital mortality was 2.8% for a total of 7547 patients. The mean patient age was 55.8 years (66.5% <65; 33.5% >/=65). Mortality for very low- to very high-volume hospitals was as follows: 3.8, 3.2, 2.4, and 1.8% (P < 0.001). Mortality for very low- to very high-volume surgeons was as follows: 4.1, 3.9, 3.1, and 1.4% (P = 0.003). Predictors of mortality in a logistic regression model were emergent admission (odds ratio [OR], 2.97; 95% confidence interval [CI], 2.02-4.38; P < 0.001), and age 65 years or greater (OR, 1.63; 95% CI, 1.16-2.30; P = 0.005). The risk of mortality was reduced for very high-volume hospitals (OR, 0.58; 95% CI, 0.35-0.97; P = 0.038) and very high-volume surgeons (OR, 0.42; 95% CI, 0.22-0.84; P = 0.012). CONCLUSION: Higher-volume providers have superior outcomes after surgical resection of malignant intracranial tumors. This reduction was maintained despite adjustment for case mix. As the regionalization of high-risk surgery moves forward, it is important for neurosurgeons to maintain leadership roles in the development of specialty-specific data collection and health policy initiatives that improve and reduce variation in outcomes.
Authors: Michael C Dewan; Ronnie E Baticulon; Krishnan Ravindran; Christopher M Bonfield; Dan Poenaru; William Harkness Journal: Childs Nerv Syst Date: 2018-07-21 Impact factor: 1.475
Authors: Christian Lopez Ramos; Michael G Brandel; Jeffrey A Steinberg; Arvin R Wali; Robert C Rennert; David R Santiago-Dieppa; Reith R Sarkar; J Scott Pannell; James D Murphy; Alexander A Khalessi Journal: J Neurooncol Date: 2018-11-20 Impact factor: 4.130
Authors: Christopher A Guidry; Timothy E Newhook; Florence E Turrentine; Min-Woong Sohn; Robert G Sawyer; R Scott Jones Journal: Ann Surg Date: 2016-03 Impact factor: 12.969
Authors: Luke M Funk; Atul A Gawande; Marcus E Semel; Stuart R Lipsitz; William R Berry; Michael J Zinner; Ashish K Jha Journal: Ann Surg Date: 2011-05 Impact factor: 12.969
Authors: Francesc Graus; Jordi Bruna; Javier Pardo; Domingo Escudero; Dolores Vilas; Inés Barceló; Marta Brell; Carmen Pascual; José A Crespo; Elena Erro; Juan C García-Romero; Jordi Estela; Juan Martino; Almudena García-Castaño; Elena Mata; Manuela Lema; Miguel Gelabert; Rafel Fuentes; Pedro Pérez; Arancha Manzano; Jesús Aguas; Antonio Belenguer; Ana Simón; Iván Henríquez; Mauricio Murcia; Rosa Vivanco; Iñigo Rojas-Marcos; David Muñoz-Carmona; Inmaculada Navas; Pablo de Andrés; Gemma Mas; Miguel Gil; Eugènia Verger Journal: Neuro Oncol Date: 2013-03-03 Impact factor: 12.300