|
|
|
|
|
|
||
|
|
||||
|
|
||||
|
||||
Surgical Neuro-Oncology |
Stephen E. and Catherine Pappas Center for Neuro-Oncology, Neurosurgical Service, Massachusetts General Hospital, and Department of Surgery (Neurosurgery), Harvard Medical School, Boston, MA 02114, USA
1 Address correspondence to Fred G. Barker, Brain Tumor Center — Cox 315, Massachusetts General Hospital, Fruit Street, Boston, MA 02114, USA (barker{at}helix.mgh.harvard.edu).
Abstract
Contemporary reports of patient outcomes after biopsy or resection of primary brain tumors typically reflect results at specialized centers. Such reports may not be representative of practices in nonspecialized settings. This analysis uses a nationwide hospital discharge database to examine trends in mortality and outcome at hospital discharge in 38,028 admissions for biopsy or resection of supratentorial primary brain tumors in adults between 1988 and 2000, particularly in relation to provider caseload. Multivariate analyses showed that large-volume centers had lower in-hospital postoperative mortality rates than centers with lighter caseloads, both for craniotomies (odds ratio [OR] 0.75 for a tenfold larger caseload) and for needle (closed) biopsies (OR 0.54). Adverse discharge disposition was also less likely at high-volume hospitals, both for craniotomies (OR 0.77) and for needle biopsies (OR 0.67). The annual number of surgical admissions increased by 53% during the 12-year study period, and in-hospital mortality rates decreased during this period, from 4.8% to 1.8%. Mortality rates decreased over time, both for craniotomies and for needle biopsies. Subgroup analyses showed larger relative mortality rate reductions at large-volume centers than at small-volume centers (73% vs. 43%, respectively). The number of U.S. hospitals performing one or more craniotomies annually for primary brain tumors decreased slightly, and the number performing needle biopsies increased. There was little change in median hospital annual craniotomy caseloads, but the largest centers had disproportionate growth in volume. The 100 highest-caseload U.S. hospitals accounted for an estimated 30% of the total U.S. surgical primary brain tumor caseload in 1988 and 41% in 2000. Our findings do not establish minimum volume thresholds for acceptable surgical care of primary brain tumors. However, they do suggest a trend toward progressive centralization of craniotomies for primary brain tumor toward large-volume U.S. centers during this interval.
References
AHRQ. Agency for Healthcare Research and Quality (2002) Calculating Nationwide Inpatient Sample Variances, 2000. Rockville, Md.: Agency for Healthcare Research and Quality.
AHRQ. Agency for Healthcare Research and Quality (2003) AHRQ Quality Indicators - Guide to Patient Safety Indicators. AHRQ Pub. 03-R203. Rockville, Md.: Agency for Healthcare Research and Quality.
Albright, A.L., Sposto, R., Holmes, E., Zeltzer, P.M., Finlay, J.L., Wisoff, J.H., Berger, M.S., Packer, R.J., and Pollack, I.F. (2000) Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors. Neurosurgery 47,879 -885.[Web of Science][Medline]
Aldape, K., Simmons, M.L., Davis, R.L., Miike, R., Wiencke, J., Barger, G., Lee, M., Chen, P., and Wrensch, M. (2000) Discrepancies in diagnoses of neuroepithelial neoplasms: The San Francisco Bay Area Adult Glioma Study. Cancer 88,2342 -2349.[CrossRef][Web of Science][Medline]
Bardach, N.S., Zhao, S., Gress, D.R., Lawton, M.T., and Johnston,
S.C. (2002) Association between subarachnoid hemorrhage outcomes
and number of cases treated at California hospitals.
Stroke 33,1851
-1856.
Barker, F.G., II, Amin-Hanjani, S., Butler, W.E., Ogilvy, C.S., and Carter, B.S. (2003a) In-hospital mortality and morbidity after surgical treatment of unruptured intracranial aneurysms in the United States, 1996-2000: The effect of hospital and surgeon volume. Neurosurgery 52,995 -1009.[CrossRef][Web of Science][Medline]
Barker, F.G., II, Klibanski, A., and Swearingen, B.
(2003b) Transsphenoidal surgery for pituitary tumors in the
United States, 1996-2000: Mortal ity, morbidity, and the effects of hospital
and surgeon volume. J. Clin. Endocrinol. Metab.
88,4709
-4719.
Begg, C.B., Cramer, L.D., Hoskins, W.J., and Brennan, M.F.
(1998) Impact of hospital volume on operative mortality for major
cancer surgery. JAMA
280,1747
-1751.
Birkmeyer, J.D., Finlayson, E.V., and Birkmeyer, C.M. (2001) Volume stan dards for high-risk surgical procedures: Potential benefits of the Leap frog initiative. Surgery 130,415 -422.[CrossRef][Web of Science][Medline]
Birkmeyer, J.D., Siewers, A.E., Finlayson, E.V., Stukel, T.A.,
Lucas, F.L., Batista, I., Welch, H.G., and Wennberg, D.E. (2002)
Hospital volume and surgical mortality in the United States. N.
Engl. J. Med. 346,1128
-1137.
Bureau of Labor Statistics (2004) Consumer Price Index: All Urban Consumers. U.S. Department of Labor, Washington, D.C. (available at ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt).
Centers for Medicare & Medicaid Services (2004).Berenson-Eggers Type of Service (BETOS) Codes . Available at http://cms.hhs.gov/data/betos/default.asp.
Chernov, M.F. (2004) The impact of provider volume on mortality after intracranial tumor resection and outcome and cost of craniotomy per formed to treat tumors in regional academic referral centers. Neurosurgery 54,1027 -1028.[CrossRef][Web of Science][Medline]
Cochrane, D.D., Kestle, J., Evans, D., and Steinbok, P. (1995) Does prac tice make perfect in treating hydrocephalus? J. Neurosurg. 82,363A (abstract).
Costa-Bouzas, J., Takkouche, B., Cadarso-Suarez, C., and Spiegelman, D. (2001) HEpiMA: Software for the identification of heterogeneity in meta-analysis. Comput. Methods Programs Biomed. 64,101 -107.[CrossRef][Web of Science][Medline]
Cowan, J.A., Jr., Dimick, J.B., Leveque, J.C., Thompson, B.G., Upchurch, G.R., Jr., and Hoff, J.T. (2003) The impact of provider volume on mor tality after intracranial tumor resection. Neurosurgery 52,48 -53.[CrossRef][Web of Science][Medline]
Cronenwett, J.L., and Birkmeyer, J.D. (2000). The Dartmouth Atlas of Vascular Health Care. Cardiovasc. Surg. 8,409 -410 (editorial).[Web of Science][Medline]
Dorward, N.L., Paleologos, T.S., Alberti, O., and Thomas, D.G. (2002) The advantages of frameless stereotactic biopsy over frame-based biopsy. Br. J. Neurosurg. 16,110 -118.[CrossRef][Web of Science][Medline]
Elixhauser, A., Steiner, C., Harris, D.R., and Coffey, R.M. (1998) Comorbid ity measures for use with administrative data. Med. Care 36,8 -27.[CrossRef][Web of Science][Medline]
Eskandar, E.N., Flaherty, A., Cosgrove, G.R., Shinobu, L.A., and Barker, F.G., II (2003) Surgery for Parkinson disease in the United States, 1996 to 2000: Practice patterns, short-term outcomes, and hospital charges in a nationwide sample. J. Neurosurg. 99,863 -871.[Web of Science][Medline]
Field, M., Witham, T.F., Flickinger, J.C., Kondziolka, D., and Lunsford, L.D. (2001) Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy. J. Neurosurg. 94,545 -551.[Web of Science][Medline]
Hall, W.A. (1998) The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82,1749 -1755.[CrossRef][Web of Science][Medline]
Halm, E. A., Lee, C., and Chassin, M.R. (2002) Is
volume related to out come in health care? A systematic review and
methodologic critique of the literature. Ann. Intern.
Med. 137,511
-520.
Harrell, F.E., Jr. (2000) Hmisc and Design libraries for S-Plus for Windows. Software and electronic documentation are available online from http://biostat.mc.vanderbilt.edu/twiki/bin/view/Main/RS.
Harrell, F.E., Jr. (2001). Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York: Springer.
Hewitt, M. (2000). Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary. Washington, D.C.: National Academies Press (available at http://books.nap.edu/catalog/10005.html).
Hewitt, M., and Petitti, D., Eds. (2001). Interpreting the Volume-Out come Relationship in the Context of Cancer Care. Washington, D.C.: National Academy Press (available at http://books.nap.edu/catalog/10160.html).
HHS. U.S. Department of Health and Human Services (1980) The International Classification of Diseases, 9th revision, Clinical Modification: ICD-9-CM. Washington, D.C.: Government Printing Office.
Hillner, B.E., Smith, T.J., and Desch, C.E. (2000)
Hospital and physician vol ume or specialization and outcomes in cancer
treatment: Importance in quality of cancer care. J. Clin.
Oncol. 18,2327
-2340.
Hoh, B.L., Rabinov, J.D., Pryor, J.C., Carter, B.S., and Barker,
F.G., II (2003) In-hospital morbidity and mortality after
endovascular treatment of unruptured intracranial aneurysms in the United
States, 1996-2000: The effect of hospital and physician volume.
AJNR Am. J. Neuroradiol.
24,1409
-1420.
Hosmer, D.W., Jr., and Lemeshow, S. (2000). Applied Logistic Regression. New York: John Wiley & Sons.
Johnston, S.C. (2000) Effect of endovascular services
and hospital volume on cerebral aneurysm treatment outcomes.
Stroke 31,111
-117.
Johnston, S.C., Zhao, S., Dudley, R.A., Berman, M.F., and Gress,
D.R. (2001) Treatment of unruptured cerebral aneurysms in
California. Stroke 32,597
-605.
Kalkanis, S.N., Eskandar, E.N., Carter, B.S., and Barker, F.G., II (2003) Microvascular decompression surgery in the United States, 1996-2000: Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52,1251 -1262.[Web of Science][Medline]
Kim, J.E., Kim, D.G., Paek, S.H., and Jung, H.W. (2003) Stereotactic biopsy for intracranial lesions: Reliability and its impact on the planning of treatment. Acta Neurochir. (Wien) 145,547 -554.[CrossRef][Medline]
Kreth, F.W., Muacevic, A., Medele, R., Bise, K., Meyer, T., and Reulen, H.J. (2001) The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours—a prospective study. Acta Neurochir. (Wien) 143,539 -545.[CrossRef][Medline]
Latif, A.Z., Signorini, D.F., and Whittle, I.R. (1998) Treatment by a specialist surgical neuro-oncologist does not provide any survival advantage for patients with a malignant glioma. Br. J. Neurosurg. 12,29 -32.[CrossRef][Web of Science][Medline]
Lee, T., Kenny, B.G., Hitchock, E.R., Teddy, P.J., Palividas, H., Harkness, W., and Meyer, C.H. (1991) Supratentorial masses: Stereotactic or free-hand biopsy? Br. J. Neurosurg. 5, 331-338.[Medline]
Loader, C.R. (1998). LOCFIT for S-Plus (software and electronic documen tation). Murray Hill, N.J.: Lucent Technologies.
Loader, C. (1999). Local Regression and Likelihood. New York: Springer-Verlag.
Long, D.M., Gordon, T., Bowman, H., Etzel, A., Burleyson, G., Betchen, S., Garonzik, I.M., and Brem, H. (2003) Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. Neurosurgery 52,1056 -1065.[CrossRef][Web of Science][Medline]
Luft, H.S., Garnick, D.W., Mark, D.H., and McPhee, S.J. (1990). Hospital Volume, Physician Volume, and Patient Outcomes: Assessing the Evi dence. Ann Arbor, Mich.: Health Administration Press.
Maitino, A.J., Levin, D.C., Parker, L., Rao, V.M., and Sunshine, J.H. (2003) Nationwide trends in rates of utilization of noninvasive diagnostic imag ing among the Medicare population between 1993 and 1999. Radiol ogy 227,113 -117.
McCullagh, P. (1980) Regression models for ordinal data. J. R. Stat. Soc. B 42,109 -142.
McCullagh, P., and Nelder, J.A. (1989). Generalized Linear Models. Lon don: Chapman and Hall.
Moses, L.E., Emerson, J.D., and Hosseini, H. (1992) Analyzing data from ordered categories. Chapter 13 in: Bailar, J.C., III, and Mosteller, F. (Eds.). Medical Uses of Statistics, 2nd Edition. Boston, Mass.: NEJM Books, pp.259 -279.
Panageas, K.S., Schrag, D., Riedel, E., Bach, P.B., and Begg, C.B.
(2003) The effect of clustering of outcomes on the association of
procedure volume and surgical outcomes. Ann. Intern.
Med. 139,658
-665.
Pollack, I.F., Boyett, J.M., Yates, A.J., Burger, P.C., Gilles, F.H., Davis, R.L., and Finlay, J.L. (2003) The influence of central review on outcome associations in childhood malignant gliomas: Results from the CCG-945 experience. Neuro-Oncol. 5, 197-207.[Abstract]
Sawin, P.D., Hitchon, P.W., Follett, K.A., and Torner, J.C. (1998) Computed imaging-assisted stereotactic brain biopsy: A risk analysis of 225 con secutive cases. Surg. Neurol. 49,640 -649.[CrossRef][Web of Science][Medline]
Scott, C.B., Nelson, J.S., Farnan, N.C., Curran, W.J., Jr., Murray, K.J., Fischbach, A.J., Gaspar, L.E., and Nelson, D.F. (1995) Central pathology review in clinical trials for patients with malignant glioma. A Report of Radiation Therapy Oncology Group 83-02. Cancer 76,307 -313.[CrossRef][Web of Science][Medline]
Smith, E.R., Butler, W.E., and Barker, F.G., II (2004a) Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: Effects of provider caseloads and progressive centralization and spe cialization of care. Neurosurgery 54,553 -563.[CrossRef][Web of Science][Medline]
Smith, E.R., Butler, W.E., and Barker, F.G., II (2004b) In-hospital mortality after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: Relation to hospital and surgeon volume of care. J. Neurosurg. Spine 100, 90-97.
Solomon, R.A., Mayer, S.A., and Tarmey, J.J. (1996)
Relationship between the volume of craniotomies for cerebral aneurysm
performed at New York state hospitals and in-hospital mortality.
Stroke 27,13
-17.
Steiner, C., Elixhauser, A., and Schnaier, J. (2002) The healthcare cost and utilization project: An overview. Eff. Clin. Pract. 5,143 -151.[Medline]
Strömberg, U. (1996) Collapsing ordered outcome
categories: A note of concern. Am. J. Epidemiol.
144,421
-424.
Tigliev, G.S., Ulitin, A., and Chernov, M.F. (1999) [The dependence of the results of the surgical treatment of patients with primary intracranial tumors on the volume of the surgical activities of a neurosurgical department (exemplified by Saint Petersburg)]. Zh. Vopr. Neirokhir. Im. N. N. Burdenko 2, 44-46.
Zhan, C., and Miller, M.R. (2003) Excess length of
stay, charges, and mor tality attributable to medical injuries during
hospitalization. JAMA
290,1868
-1874.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  E. R. Smith, D. Zurakowski, A. Saad, R. M. Scott, and M. A. Moses Urinary Biomarkers Predict Brain Tumor Presence and Response to Therapy Clin. Cancer Res., April 15, 2008; 14(8): 2378 - 2386. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
