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01.01.2020 | Clinical Study

Hospital teaching status associated with reduced inpatient mortality and perioperative complications in surgical neuro-oncology

verfasst von: Evan M. Luther, David McCarthy, Katherine M. Berry, Nikhil Rajulapati, Ashish H. Shah, Daniel G. Eichberg, Ricardo J. Komotar, Michael Ivan

Erschienen in: Journal of Neuro-Oncology | Ausgabe 2/2020

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Abstract

Purpose

Studies have demonstrated that higher surgical volumes correlate with improved neurosurgical outcomes yet none exist evaluating the effects of hospital teaching status on the surgical neuro-oncology patient. We present the first analysis comparing brain tumor surgery perioperative outcomes at academic and non-teaching centers.

Methods

Brain tumor surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. A teaching hospital, defined by the NIS, must have ≥ 1 Accreditation Council of Graduate Medical Education (ACGME) approved residency programs, Council of Teaching Hospitals membership, or have a ratio ≥ 0.25 of full-time residents to hospital beds. Annual treatment trends were stratified by hospital teaching status, assessing yearly caseload with linear regression. Multivariable logistic regression determined predictors of inpatient mortality/complications. Hospitals were further divided into quartiles by case volume and teaching status was compared in each.

Results

Teaching hospitals (THs) exhibited an average annual increase in brain tumor surgeries (+ 1057/year, p < 0.0001). In multivariable analysis, teaching status was associated with decreased risk of mortality (OR 0.82, p = 0.0003) and increased likelihood of discharge home (OR 1.21, p < 0.0001). In subgroup analysis, within the highest hospital quartile by caseload, higher mortality rates and lower routine discharges were again seen at non-teaching hospitals (NTHs) (p = 0.0002 and p = 0.0016, respectively).

Conclusion

THs are performing more brain tumor surgeries over time with lower rates of inpatient mortality and perioperative complications even after controlling for hospital case volume. These results suggest a shift in neuro-oncology practice patterns favoring THs to optimize patient outcomes especially at the highest volume centers.

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Titel: Hospital teaching status associated with reduced inpatient mortality and perioperative complications in surgical neuro-oncology
verfasst von: Evan M. Luther
David McCarthy
Katherine M. Berry
Nikhil Rajulapati
Ashish H. Shah
Daniel G. Eichberg
Ricardo J. Komotar
Michael Ivan
Publikationsdatum: 01.01.2020
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 2/2020
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-020-03395-x

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