Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Because of the limited data available regarding the associations between risk factors and the effect of hospital case volume on outcomes after resection of intradural spine tumors, the authors attempted to identify these associations by using a large population-based database.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Using the National Inpatient Sample database, the authors performed a retrospective cohort study that involved patients who underwent surgery for an intradural spinal tumor between 2002 and 2011. Using national estimates, they identified associations of patient demographics, medical comorbidities, and hospital characteristics with inpatient postoperative outcomes. In addition, the effect of hospital volume on unfavorable outcomes was investigated. Hospitals that performed fewer than 14 resections in adult patients with an intradural spine tumor between 2002 and 2011 were labeled as low-volume centers, whereas those that performed 14 or more operations in that period were classified as high-volume centers (HVCs). These cutoffs were based on the median number of resections performed by hospitals registered in the National Inpatient Sample during the study period.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Overall, 18,297 patients across 774 hospitals in the United States underwent surgery for an intradural spine tumor. The mean age of the cohort was 56.53 ± 16.28 years, and 63% were female. The inpatient postoperative risks included mortality (0.3%), discharge to rehabilitation (28.8%), prolonged length of stay (&gt; 75th percentile) (20.0%), high-end hospital charges (&gt; 75th percentile) (24.9%), wound complications (1.2%), cardiac complications (0.6%), deep vein thrombosis (1.4%), pulmonary embolism (2.1%), and neurological complications, including durai tears (2.4%). Undergoing surgery at an HVC was significantly associated with a decreased chance of inpatient mortality (OR 0.39; 95% CI 0.16−0.98), unfavorable discharge (OR 0.86; 95% CI 0.76−0.98), prolonged length of stay (OR 0.69; 95% CI 0.62−0.77), high-end hospital charges (OR 0.67; 95% CI 0.60−0.74), neurological complications (OR 0.34; 95% CI 0.26−0.44), deep vein thrombosis (OR 0.65; 95% CI 0.45−0.94), wound complications (OR 0.59; 95% CI 0.41−0.86), and gastrointestinal complications (OR 0.65; 95% CI 0.46−0.92).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The results of this study provide individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics and shows a decreased risk for most unfavorable outcomes for those who underwent surgery at an HVC. These findings could be used as a tool for risk stratification, directing presurgical evaluation, assisting with surgical decision making, and strengthening referral systems for complex cases.</jats:p></jats:sec>

Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

“…Few studies have discussed healthcare utilization associated with intradural spinal tumors 14,15,24,41 as compared to multiple studies assessing costs in the treatment of metastatic epidural spinal cord compression. [25][26][27]42,43 Sharma et al 14 reported that the mean total hospital charges for treating intramedullary spine tumors in the National Inpatient Sample from 2003 to 2010 was $61 157.…”

“…Several studies exist assessing efficacy, surgical approach, and complications associated with surgery for IDEM tumors. 5,[11][12][13][14][15] The estimated healthcare burden of treating patients with spinal disorders ranges from $80 to $100 billion. [16][17][18][19][20] Given the unsustainable cost of the current US healthcare system, value-based NEUROSURGERY VOLUME 81 | NUMBER 4 | OCTOBER 2017 | 613 Downloaded from https://academic.oup.com/neurosurgery/article-abstract/81/4/613/3813676 by guest on 08 June 2019 purchasing is being rapidly implemented.…”

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

“…Previous studies have explored the volume-outcome relationship in the context of several neurosurgical procedures, [2][3][4][5][6]15,16,23,24,26,28,29,44,51,54 including those involving the spine. 17,20,28,42,43 For scoliosis surgery, Patil et al 41 defined 5 hospital surgical volume cutoffs ranging from < 21 operations per year to > 147 per year.…”

“…17,20,28,42,43 For scoliosis surgery, Patil et al 41 defined 5 hospital surgical volume cutoffs ranging from < 21 operations per year to > 147 per year. Further, the authors investigated in-hospital mortality, discharge disposition, and complications following surgical correction.…”

We Need to Talk about Lumbar Total Disc Replacement

“…Clearly, where an insurance-dominated health care system does not provide financial cover for the subscriber's preferred treatment option of a proven noninferior procedure, demand for the procedure will be low (and this, in turn, will have implications for surgical volume and corollary adverse implications for retention of appropriate spinal surgical skills 674 ). And if the eligibility criteria for supporting the procedure are too restrictive and fail to reflect advances since the initial trials that have confirmed noninferiority of LTDR when compared with fusion, patient demand and surgical skills are adversely affected.…”