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Surgery for primary supratentorial brain tumors in the United States,
1988 to 2000: The effect of provider caseload and centralization of
care
Fred G. Barker II, William T. Curry Jr., and
Bob S. Carter
Stephen E. and Catherine Pappas Center for
Neuro-Oncology, Neurosurgical Service, Massachusetts General Hospital,
and Department of Surgery (Neurosurgery), Harvard Medical School,
Boston, MA 02114, USA. Address
correspondence to Fred G. Barker, Brain Tumor Center — Cox 315, Massachusetts General
Hospital, Fruit Street, Boston, MA 02114, USA
(barker@helix.mgh.harvard.edu).
Contemporary reports of patient outcomes after biopsy or resection
of primary brain tumors typically reflect results at specialized
centers.
Such reports may not be representative of practices in
nonspecialized settings.
This analysis uses a nationwide hospital
discharge database to examine trends in mortality and outcome at
hospital discharge in 38,028 admissions for biopsy or resection of
supratentorial primary brain tumors in adults between 1988 and 2000,
particularly in relation to provider caseload.
Multivariate analyses
showed that large-volume centers had lower in-hospital postoperative
mortality rates than centers with lighter caseloads, both for
craniotomies (odds ratio [OR] 0.75 for a tenfold larger caseload) and
for needle (closed) biopsies (OR 0.54).
Adverse discharge disposition
was also less likely at high-volume hospitals, both for craniotomies
(OR 0.77) and for needle biopsies (OR 0.67).
The annual number of
surgical admissions increased by 53% during the 12-year study period,
and in-hospital mortality rates decreased during this period, from
4.8% to 1.8%.
Mortality rates decreased over time, both for
craniotomies and for needle biopsies.
Subgroup analyses showed larger
relative mortality rate reductions at large-volume centers than at
small-volume centers (73% vs. 43%, respectively).
The number of U. S.
hospitals performing one or more craniotomies annually for primary
brain tumors decreased slightly, and the number performing needle
biopsies increased.
There was little change in median hospital annual
craniotomy caseloads, but the largest centers had disproportionate
growth in volume.
The 100 highest-caseload U. S. hospitals accounted
for an estimated 30% of the total U. S. surgical primary brain tumor
caseload in 1988 and 41% in 2000.
Our findings do not establish
minimum volume thresholds for acceptable surgical care of primary
brain tumors.
However, they do suggest a trend toward progressive
centralization of craniotomies for primary brain tumor toward
large-volume U. S. centers during this interval.
© 2005 Duke University Press
Source: http://hermia.ingentaselect.com/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v7n1/s6/p49&user_id=undefined
DOI: http://dx.doi.org/10.1215/S1152851704000146
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