Craniotomy for Glioma Resection: A Predictive Model

Missios, Symeon; Kalakoti, Piyush; Nanda, Anil; Bekelis, Kimon

doi:10.1016/j.wneu.2015.04.052

Cited by 27 publications

(17 citation statements)

References 31 publications

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“…To our knowledge there is no prior literature reporting specific hospitalization and physician fees for craniotomies for tumor resection. All available studies report cost at the population level without its specific components [8,[10][11][12].…”

Section: Exposure Variablesmentioning

confidence: 99%

Regional disparities in hospitalization charges for patients undergoing craniotomy for tumor resection in New York State: correlation with outcomes

Missios

Bekelis

2016

J Neurooncol

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There is increasing regulatory pressure for cost containment in neuro-oncology, and rationalization of the observed regional disparities. We investigated the presence of such disparities in New York State and examined the impact of risk adjustment on the magnitude of this variation. We performed a cohort study involving patients with brain tumors (gliomas, metastases, or meningiomas), who underwent craniotomy for resection from 2009 to 2013, and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. A linear regression model was utilized for risk-adjustment of inpatient charges using socioeconomic factors and comorbidities. Hospitals with fewer than 20 craniotomies were excluded. 13,535 patients underwent treatment, including 5032 (37.2 %) gliomas, 4858 (35.9 %) metastases, and 3645 (26.9 %) meningiomas. Unadjusted median hospitalization charges ranged from $22,954 to $177,398 at the hospital level, and $30,086 to $159,281 at the county level. Despite extensive risk-adjustment we observed persistent disparities with median hospitalization charges ranging from $40,455 to $124,691 at the hospital level, and $53,999 to $94,844 at the county level. Analysis of variance (ANOVA) demonstrated that these disparities were significant at the facility and the county level (P < 0.0001). Increased charges were not associated with shorter LOS (r = 0.10, P = 0.41), or lower rates of death (r = 0.09, P = 0.46), and unfavorable discharge (r = 0.24, P = 0.06). Using a comprehensive all-payer cohort of patients with brain tumors in New York State we identified wide disparities at the hospital and the county level despite comprehensive risk-adjustment. Increased charges were not associated with shorter LOS, or lower rates of death and unfavorable discharge.

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Section: Exposure Variablesmentioning

confidence: 99%

Regional disparities in hospitalization charges for patients undergoing craniotomy for tumor resection in New York State: correlation with outcomes

Missios

Bekelis

2016

J Neurooncol

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“…This observation has also been described in previous studies looking at morbidity and mortality after cranial neurosurgical procedures, and might be attributed to unmeasured confounding variables, such as the pathology of the lesion, which unfortunately are not available in the NSQIP. 24,25 Alternatively, older male patients may have been less likely than younger adults to have a caregiver, and this in addition to other socioeconomic factors may have complicated discharge.…”

Section: Discussionmentioning

confidence: 99%

Thirty-day postoperative morbidity and mortality after temporal lobectomy for medically refractory epilepsy

Kerezoudis

McCutcheon

Murphy

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Temporal lobectomy is a well-established treatment modality for the management of medically refractory epilepsy in appropriately selected patients. The aim of this study was to assess 30-day morbidity and mortality after temporal lobectomy in cases registered in a national database. METHODS A retrospective cohort analysis was conducted using a multiinstitutional surgical registry compiled between 2006 and 2014. The authors identified patients who underwent anterior temporal lobectomy and/or amygdalohippocampectomy for a primary diagnosis of intractable epilepsy. Univariate and multivariable analyses with regard to patient demographics, comorbidities, operative characteristics, and 30-day outcomes were applied. RESULTS A total of 216 patients were included in the study. The median age was 38 years and 46% of patients were male. The median length of stay was 3 days and the 30-day mortality rate was 1.4%. Fourteen patients (6.5%) developed at least one major complication. Return to the operating room was observed in 7 patients (3.2%). Readmission within 30 days and discharge to a location other than home were available for 2011-2014 (n = 155) and occurred in 11% and 10.3% of patients, respectively. Multivariable regression analysis revealed that increasing age was an independent predictor of discharge disposition other than home and that male sex was a significant risk factor for the development of a major complication. Interestingly, the presence of the attending neurosurgeon and a resident during the procedure was significantly associated with decreased odds of prolonged length of stay (i.e., > 75th percentile [5 days]) and discharge to a location other than home. CONCLUSIONS Using a multiinstitutional surgical registry, 30-day outcome data after temporal lobectomy for medically intractable epilepsy demonstrates a mortality rate of 1.4%, a major complication rate of 6.5%, and a readmission rate of 11%. Temporal lobectomy is an extremely effective therapy for seizures originating there-however, surgical intervention must be weighed against its morbidity and mortality outcomes.

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“…Several multicenter studies have previously investigated the short-term incidence of and risk factors for VTE after brain tumor surgery [ 3 , 13 , 39 – 45 ], of which four studies focused on glioma patients [ 3 , 13 , 39 , 41 ]. From these studies, the rate of VTE following craniotomy is cited as 3.3–7.5% for glioma patients [ 3 , 13 , 39 , 41 ] and 2.3–4.0% for brain tumors patients in general [ 11 , 40 – 42 , 44 ], with a follow-up ranging from solely the initial hospital stay to 6 weeks after surgery. The 30-day VTE rate was as high as 9.3% when asymptomatic DVTs were included too [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…From these studies, the rate of VTE following craniotomy is cited as 3.3–7.5% for glioma patients [ 3 , 13 , 39 , 41 ] and 2.3–4.0% for brain tumors patients in general [ 11 , 40 – 42 , 44 ], with a follow-up ranging from solely the initial hospital stay to 6 weeks after surgery. The 30-day VTE rate was as high as 9.3% when asymptomatic DVTs were included too [ 3 ]. These results are comparable to the VTE rates found in the current study and suggest a higher rate of VTE in glioma patients postoperatively compared to other brain tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have identified older age, male sex, Hispanic ethnicity, history of craniotomy, history of VTE, congestive heart failure, coagulopathy, seizures, increased stay on the intensive care unit, prolonged hospital stay, medium bed size, residual tumor tissue, and absence of thromboprophylactic therapy as predictors of VTE after craniotomy for primary malignant brain tumors [ 3 , 4 , 6 , 12 – 15 ]. Most of these studies have been small, single-center studies, and none of these studies have identified predictors or performed time-to-event analyses separated for VTE type (DVT vs. PE) and the clinical setting (hospitalized vs. post-discharge patients).…”

Section: Introductionmentioning

confidence: 99%

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Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

et al. 2017

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Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently complicates the postoperative course of primary malignant brain tumor patients. Thromboprophylactic anticoagulation is commonly used to prevent VTE at the risk of intracranial hemorrhage (ICH). We extracted all patients who underwent craniotomy for a primary malignant brain tumor from the National Surgical Quality Improvement Program (NSQIP) registry (2005–2015) to perform a time-to-event analysis and identify relevant predictors of DVT, PE, and ICH within 30 days after surgery. Among the 7376 identified patients, the complication rates were 2.6, 1.5, and 1.3% for DVT, PE, and ICH, respectively. VTE was the second-most common major complication and third-most common reason for readmission. ICH was the most common reason for reoperation. The increased risk of VTE extends beyond the period of hospitalization, especially for PE, whereas ICH occurred predominantly within the first days after surgery. Older age and higher BMI were overall predictors of VTE. Dependent functional status and longer operative times were predictive for VTE during hospitalization, but not for post-discharge events. Admission two or more days before surgery was predictive for DVT, but not for PE. Preoperative steroid usage and male gender were predictive for post-discharge DVT and PE, respectively. ICH was associated with various comorbidities and longer operative times. This multicenter study demonstrates distinct critical time periods for the development of thrombotic and hemorrhagic events after craniotomy. Furthermore, the VTE risk profile depends on the type of VTE (DVT vs. PE) and clinical setting (hospitalized vs. post-discharge patients).

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Craniotomy for Glioma Resection: A Predictive Model

Cited by 27 publications

References 31 publications

Regional disparities in hospitalization charges for patients undergoing craniotomy for tumor resection in New York State: correlation with outcomes

Regional disparities in hospitalization charges for patients undergoing craniotomy for tumor resection in New York State: correlation with outcomes

Thirty-day postoperative morbidity and mortality after temporal lobectomy for medically refractory epilepsy

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

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