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    
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.
William T Curry; Michael W McDermott; Bob S Carter; Fred G Barker
Related Documents :
22401315 - Carvedilol or propranolol in portal hypertension? a randomized comparison.
18376125 - Impact of telemedical care and monitoring on morbidity in mild to moderate chronic hear...
22326695 - Predictors of outcome after endovascular repair for chronic type b dissection.
22726465 - Placement of fully covered self-expandable metal stents in patients with locally advanc...
23295135 - Office-based ureteral stent placement under local anesthesia for obstructing stones is ...
18254075 - Treatment for peritoneal dialysis-associated peritonitis.
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    
Brain Tumor Center, Neurosurgical Service, Massachusetts General Hospital, Boston 02114, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Centralized Hospital Services / statistics & numerical data
Cohort Studies
Craniotomy / mortality*
Databases, Factual
Hospital Mortality / trends
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
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

Previous Document:  Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Pa...
Next Document:  Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 pat...