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Surgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes After Brain Tumor Resection.

TitleSurgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes After Brain Tumor Resection.
Publication TypeJournal Article
Year of Publication2018
AuthorsRamakrishna R, Hsu W-C, Mao J, Sedrakyan A
JournalWorld Neurosurg
Volume114
Paginatione254-e266
Date Published2018 Jun
ISSN1878-8769
KeywordsAdult, Age Factors, Aged, Aged, 80 and over, Brain Neoplasms, Clinical Competence, Cohort Studies, Community Health Planning, Female, Hospitals, High-Volume, Humans, Length of Stay, Male, Middle Aged, New York, Outcome Assessment, Health Care, Patient Readmission, Postoperative Complications, Surgeons
Abstract

OBJECTIVE: Surgeon volume has been previously shown to affect patient outcomes. However, data related to neuro-oncologic surgery are limited and do not include neurologic morbidities as an outcomes measure. In this study, we aimed to determine if 5-year surgeon cumulative and annual volumes predict early postoperative outcomes in patients after brain tumor surgery.

METHODS: A population-based cohort of patients (n = 10,258) undergoing brain tumor resection between 2005 and 2014 were included for study using the New York Statewide Planning and Research Cooperation System. Surgeons were categorized by their cumulative and annual surgical volume.

RESULTS: Patients treated by high cumulative/high annual (HC/HA) volume surgeons had shorter length of stay (median, 5 days vs. 8 days vs. 8 days vs. 6 days, respectively; P < 0.01), lower charges (median, 70,025 vs. $77,043 vs. $93,715 vs. $77,018 respectively; P < 0.01) and less nonroutine discharge (41% vs. 48% vs. 50.9% vs. 43.9% respectively; P < 0.01) compared with patients treated by surgeons from the low cumulative/low annual (LC/LA), LC/HA, HC/LA groups. Similarly, HC/HA volume surgeons also had lower rate of hydrocephalus (9.9% vs. 10.4% vs. 13.7% respectively; P = 0.02), medical complications (6.9% vs. 11.2% vs. 11.5% respectively; P < 0.01), neurologic complications (44.1% vs. 46.8% vs. 48.1% respectively; P = 0.03), 30-day reoperation (5.1% vs. 6.9% vs. 7.1% respectively; P < 0.01) and 30-day death (3.3% vs. 5.4% vs. 5.2%; P < 0.01) compared with LC/LA and LC/HA volume surgeons.

CONCLUSIONS: There is some evidence for improved postoperative outcomes when surgery is performed by HC and HA volume surgeons. This finding suggests that subspecialization in surgical neuro-oncology should be considered.

DOI10.1016/j.wneu.2018.02.172
Alternate JournalWorld Neurosurg
PubMed ID29524715
Grant ListU01 FD005478 / FD / FDA HHS / United States