Subspecialisation in neurosurgery—does size matter?

Chumas, Paul; Kenny, Tom; Stiller, Charles

doi:10.1007/s00701-011-0970-0

Cited by 10 publications

(4 citation statements)

References 14 publications

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“…Although the benefits of centralization of specialized, low‐volume, and high‐cost care are intuitively obvious, scientific proof is still lacking . Luft presented the argument in 1979, and many authors since then report data supportive of this concept .…”

Section: The Safe and Sustainable Processmentioning

confidence: 99%

Designing a safe and sustainable pediatric neurosurgical practice: the English experience

Young

2014

Pediatric Anesthesia

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The 2001 Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995 stated that there must be standards for hospitals as a whole and that hospitals, which do not meet these standards, should not be able to offer services within the National Health Service (NHS). In 2013, agreed standards for pediatric neurosurgery were produced. Between 2001 and 2013 several key documents were published, which formed the background to the review that produced these standards:, the 'Safe and Sustainable' review. The process had the mission statement, 'Safe, sustainable and world class. Not ordinary, OK or just good enough.' In April 2013, the new commissioning structure of NHS England came into being. Clinical Reference Groups (reporting directly into the new structure) and pediatric neurosurgical operational delivery networks are taking the Safe and Sustainable pediatric neurosurgery standards and models of care into practice in England. Effective outcome data collection will allow us to assess whether these networks will improve equity of access for English children to world-class pediatric neurosurgical care and reduce the variation in outcomes seen at the present time.

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Section: The Safe and Sustainable Processmentioning

confidence: 99%

Designing a safe and sustainable pediatric neurosurgical practice: the English experience

Young

2014

Pediatric Anesthesia

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“…10,34 Because the NRCT does not collect data on the individual surgeon performing the procedure, we therefore cannot comment on the association. Regardless, the small number of tumor operations being performed by each surgeon would preclude using 30-day mortality rate as a possible differentiator.…”

Section: Institutional Comparisons Of Uk Datamentioning

confidence: 99%

United Kingdom 30-day mortality rates after surgery for pediatric central nervous system tumors

O’Kane

Mathew

Kenny

et al. 2013

PED

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Object In an increasing culture of medical accountability, 30-day operative mortality rates remain one of the most objective measurements reported for the surgical field. The authors report population-based 30-day postoperative mortality rates among children who had undergone CNS tumor surgery in the United Kingdom. Methods To determine overall 30-day operative mortality rates, the authors analyzed the National Registry of Childhood Tumors for CNS tumors for the period 2004–2007. The operative mortality rate for each tumor category was derived. In addition, comparison was made with the 30-day operative mortality rates after CNS tumor surgery reported in the contemporary literature. Finally, by use of a funnel plot, institutional performance for 30-day operative mortality was compared for all units across the United Kingdom. Results The overall 30-day operative mortality rate for children undergoing CNS tumor surgery in the United Kingdom during the study period was 2.7%. When only malignant CNS tumors were analyzed, the rate increased to 3.5%. One third of the deaths occurred after discharge from the hospital in which the surgery had been performed. The highest 30-day operative mortality rate (19%) was for patients with choroid plexus carcinomas. A total of 20 institutions performed CNS tumor surgery during the study period. Rates for all institutions fell within 2 SDs. No trend associating operative mortality rates and institutional volume was found. In comparison, review of the contemporary literature suggests that the postoperative mortality rate should be approximately 1%. Conclusions The authors believe this to be the first report of national 30-day surgical mortality rates specifically for children with CNS tumors. The study raises questions about the 30-day mortality rate among children undergoing surgery for CNS tumors. International consensus should be reached on a minimum data set for outcomes and should include 30-day operative mortality rates.

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“…Surgery is not always performed by a pediatric neurosurgeon, which can affect the quality of the resection. Several reports have indicated that pediatric neurosurgeons achieve better results with fewer postoperative complications, such as cerebellar mutism 25–27 . These same factors that negatively impact survival outcomes in HICs are likely present, if not exacerbated, in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil

Oigman

Osorio

Ferman

et al. 2021

Pediatric Blood & Cancer

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Background Medulloblastoma (MB),the most common malignant brain tumor of childhood has survival outcomes exceeding 80% for standard‐risk and 60% for high‐risk patients in high‐income countries (HICs). These results have not been replicated in low‐ and middle‐income countries (LMICs), where 80% of children with cancer live. Methods This is a retrospective review of 114 children aged 3–18 years diagnosed with MB from 1997 to 2016 at National Cancer Institute (INCA). Sociodemographic, clinical, and treatment data were extracted from the medical records and summarized descriptively. Overall survival (OS) and progression‐free survival (PFS) were calculated using the Kaplan–Meier method. Results The male‐to‐female ratio was 1.32 and the median age at diagnosis was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most common presenting symptoms. Five‐year OS was 59.1% and PFS was 58.4%. The OS for standard‐risk and high‐risk patients was 69% and 53%, respectively. The median time to diagnosis interval was 50.5 days and the median time from surgery to radiation therapy initiation was 50.4 days. Patients who lived >40 km from INCA fared better (OS = 68.2% vs. 51.1%, p = .032). Almost 20% of families lived below the Brazilian minimum wage. Forty‐five patients (35%) had metastatic disease at admission. Gross total resection was achieved in 57% of the patitents. Conclusions Although there are considerable barriers to deliver effective MB treatment in countries like Brazil, the OS seen in the present study demonstrates that good outcomes are not only feasible but can and should be increased with appropriate interventions.

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Subspecialisation in neurosurgery—does size matter?

Cited by 10 publications

References 14 publications

Designing a safe and sustainable pediatric neurosurgical practice: the English experience

Designing a safe and sustainable pediatric neurosurgical practice: the English experience

United Kingdom 30-day mortality rates after surgery for pediatric central nervous system tumors

Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil

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