Daisuke Shinjo1, Kimikazu Matsumoto2, Keita Terashima2, Tetsuya Takimoto2, Tetsu Ohnuma3, Takashi Noguchi1, Kiyohide Fushimi4. 1. Department of Information Technology and Management, The National Center of Child Health and Development, Japan. 2. Children's Cancer Center, The National Center of Child Health and Development, Japan. 3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA; Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan. 4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan. Electronic address: kfushimi.hci@tmd.ac.jp.
Abstract
BACKGROUND: Paediatric brain tumours are the second most common type of malignancies that occur during childhood. Surgical resection is usually the first step in the treatment of these patients; however, evidence pertaining to a 'volume effect' in paediatric brain tumour resection surgery and the associations among the surgical volume, clinical features and treatments are not well characterised. METHODS: Data pertaining to paediatric patients (age ≤ 15 years) who underwent brain tumour resection surgery between April 2012 and March 2016 were retrieved from the Japanese administrative inpatient database and retrospectively analysed. Demographic characteristics, therapeutic procedures and in-hospital mortality were summarised according to the hospital surgical volume. Penalised logistic regression analysis was used to investigate the association between the hospital surgical volume and in-hospital mortality. RESULTS: A total of 1354 paediatric patients were included. About 40% of the patients were in the 11- to 15-year age group. The male:female ratio was 53:47, the overall crude in-hospital mortality was 1.8% (n = 24) and the 30-day postoperative mortality was 0.4% (n = 6). The crude mortality ratio was 3.3% in the lowest quartile and 0.8% in the highest quartile by volume. After adjusting for covariates, a higher hospital surgical volume was associated with lower in-hospital mortality (compared with 1-4 surgeries per 4 years, 15-25 surgeries, odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.05-0.90, p = 0.033; ≥26 surgeries, OR: 0.31; 95% CI: 0.08-0.96, p = 0.042). CONCLUSIONS: The present study indicated a volume-outcome relationship in paediatric brain tumour resection surgery cases. Further centralisation of surgeries should be considered to achieve better outcomes.
BACKGROUND: Paediatric brain tumours are the second most common type of malignancies that occur during childhood. Surgical resection is usually the first step in the treatment of these patients; however, evidence pertaining to a 'volume effect' in paediatric brain tumour resection surgery and the associations among the surgical volume, clinical features and treatments are not well characterised. METHODS: Data pertaining to paediatric patients (age ≤ 15 years) who underwent brain tumour resection surgery between April 2012 and March 2016 were retrieved from the Japanese administrative inpatient database and retrospectively analysed. Demographic characteristics, therapeutic procedures and in-hospital mortality were summarised according to the hospital surgical volume. Penalised logistic regression analysis was used to investigate the association between the hospital surgical volume and in-hospital mortality. RESULTS: A total of 1354 paediatric patients were included. About 40% of the patients were in the 11- to 15-year age group. The male:female ratio was 53:47, the overall crude in-hospital mortality was 1.8% (n = 24) and the 30-day postoperative mortality was 0.4% (n = 6). The crude mortality ratio was 3.3% in the lowest quartile and 0.8% in the highest quartile by volume. After adjusting for covariates, a higher hospital surgical volume was associated with lower in-hospital mortality (compared with 1-4 surgeries per 4 years, 15-25 surgeries, odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.05-0.90, p = 0.033; ≥26 surgeries, OR: 0.31; 95% CI: 0.08-0.96, p = 0.042). CONCLUSIONS: The present study indicated a volume-outcome relationship in paediatric brain tumour resection surgery cases. Further centralisation of surgeries should be considered to achieve better outcomes.
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: Gynecol Oncol Date: 2020-01-22 Impact factor: 5.482