Document Detail


Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload.
MedLine Citation:
PMID:  16028755     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The goal of this study was to determine the risk of adverse outcomes after contemporary surgical treatment of meningiomas in the US and trends in patient outcomes and patterns of care. METHODS: The authors performed a retrospective cohort study by using the Nationwide Inpatient Sample covering the period of 1988 to 2000. Multivariate regression models with disposition end points of death and hospital discharge were used to test patient, surgeon, and hospital characteristics, including volume of care, as outcome predictors. Multivariate analyses revealed that larger-volume centers had lower mortality rates for patients who underwent craniotomy for meningioma (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.59-0.93, p = 0.01). Adverse discharge disposition was also less likely at high-volume hospitals (OR 0.71, 95% CI 0.62-0.80, p < 0.001). With respect to the surgeon caseload, there was a trend toward a lower rate of mortality after surgery when higher-caseload providers were involved, and a significantly less frequent adverse discharge disposition (OR 0.71, 95% CI 0.62-0.80, p < 0.001). The annual meningioma caseload in the US increased 83% between 1988 and 2000, from 3900 patients/year to 7200 patients/year. In-hospital mortality rates decreased 61%, from 4.5% in 1988 to 1.8% in 2000. Reductions in the mortality rates were largest at high-volume centers (a 72% reduction in the relative mortality rate at largest-volume-quintile centers, compared with a 6% increase in the relative mortality rate at lowest-volume-quintile centers). The number of US hospitals where craniotomies were performed for meningiomas increased slightly. Fewer centers hosted one meningioma resection annually, whereas the largest centers had disproportionate increases in their caseloads, indicating a modest centralization of meningioma surgery in the US during this interval. CONCLUSIONS: The mortality and adverse hospital discharge disposition rates were lower when meningioma surgery was performed by high-volume providers. The annual US caseload increased, whereas the mortality rates decreased, especially at high-volume centers.
Authors:
William T Curry; Michael W McDermott; Bob S Carter; Fred G Barker
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  102     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-07-20     Completed Date:  2005-08-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  977-86     Citation Subset:  AIM; IM    
Affiliation:
Brain Tumor Center, Neurosurgical Service, Massachusetts General Hospital, Boston 02114, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Centralized Hospital Services / statistics & numerical data
Cohort Studies
Craniotomy / mortality*
Databases, Factual
Female
Hospital Mortality / trends
Humans
Male
Meningeal Neoplasms / mortality*,  surgery*
Meningioma / mortality*,  surgery*
Middle Aged
Multivariate Analysis
Neurosurgery / statistics & numerical data
Postoperative Complications / mortality
Retrospective Studies
Risk Factors
United States / epidemiology
Comments/Corrections
Comment In:
J Neurosurg. 2005 Jun;102(6):969-70; discussion 970   [PMID:  16028752 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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