Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery

Abstract

Introduction For decisions on glioblastoma surgery, the risk of complications and decline in performance is decisive. In this study, we determine the rate of complications and performance decline after resections and biopsies in a national quality registry, their risk factors and the risk-standardized variation between institutions. Methods Data from all 3288 adults with first-time glioblastoma surgery at 13 hospitals were obtained from a prospective population-based Quality Registry Neuro Surgery in the Netherlands between 2013 and 2017. Patients were stratified by biopsies and resections. Complications were categorized as Clavien-Dindo grades II and higher. Performance decline was considered a deterioration of more than 10 Karnofsky points at 6 weeks. Risk factors were evaluated in multivariable logistic regression analysis. Patient-specific expected and observed complications and performance declines were summarized for institutions and analyzed in funnel plots. Results For 2271 resections, the overall complication rate was 20 % and 16 % declined in performance. For 1017 biopsies, the overall complication rate was 11 % and 30 % declined in performance. Patient-related characteristics were significant risk factors for complications and performance decline, i.e. higher age, lower baseline Karnofsky, higher ASA classification, and the surgical procedure. Hospital characteristics, i.e. case volume, university affiliation and biopsy percentage, were not. In three institutes the observed complication rate was significantly less than expected. In one institute significantly more performance declines were observed than expected, and in one institute significantly less. Conclusions Patient characteristics, but not case volume, were risk factors for complications and performance decline after glioblastoma surgery. After risk-standardization, hospitals varied in complications and performance declines.

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

“…In our experience and that of others, using smaller incisions with more focused craniotomies, or the natural endonasal corridor facilitate less brain exposure, rapid healing, reduced pain need for narcotics, and a greater willingness for patients to mobilize and leave the hospital soon after surgery [15,17,31,33,[39][40][41]. Similarly, strict complication avoidance protocols help facilitate short LOS, reduced ICU use, and lower overall complication rates [42,43]. For example, the measures we routinely employ of surgical navigation, Doppler ultrasound for vessel localization, endoscopy for maximizing visualization and strict skull base closure protocols to avoid CSF leaks in aggregate are associated with a low rate of new neurological deficits (1%, 3/317 operations) and a low CSF leak rate of 1.2% (4/317 operations) with no cases of meningitis [16,17].…”

Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas – a retrospective population based study

“…Since this is not a randomized study, these results might be explained by selection bias or by a most likely, co-variation between resection and non-multifocal tumours. Having a resection instead of a biopsy has been identified as a risk factor for complications in other materials [ 28 ]. We could not detect any association between increase in postoperative morbidity and preoperative WHO-PS in contrast to findings in other studies suggesting poor performance status or frailty as a risk factor for this outcome [ 28 – 30 ].…”

“…Having a resection instead of a biopsy has been identified as a risk factor for complications in other materials [ 28 ]. We could not detect any association between increase in postoperative morbidity and preoperative WHO-PS in contrast to findings in other studies suggesting poor performance status or frailty as a risk factor for this outcome [ 28 – 30 ]. Our findings are, however, in line with those of Karsy et al with a similar (older) age group showing no difference in median preoperative Karnofsky-score between patients with and without complications [ 26 ].…”

Between-hospital variation in time to glioblastoma surgery: a report from the Quality Registry Neuro Surgery in the Netherlands

“…In previous studies, between-hospital variation in complications, decline in patient performance after surgery, and survival have been reported from this registry. 17,18 Data were obtained and de-identified by the trusted third party Stichting Informatievoorziening Zorg, a national institute concerned with the registration and data handling of health care institutes in the Netherlands. Ethical approval was waived to perform this study and individual written informed consent was not needed because the study was not subject to the Medical Research Involving Human Subjects Act.…”