Abstract
The objective of the present study was to analyze the risk of in-patient mortality, adverse outcome, practice patterns and regional variations in patients who underwent intracranial meningioma surgery in the United States between 2001 and 2010. We performed a retrospective cohort study using the Nationwide Inpatient Sample database. In-patient mortality and adverse outcome at discharge were the outcome predictors. Multivariate analyses were done to analyze the patient, hospital and physician characteristics. The annual case-volume of patients with meningioma increased from 2001 to 2010 by 40 %. The in-patient mortality rate remained the same at 1.3 % and the rate of adverse discharge disposition remained at 35 % between 2001 and 2010. Caucasian female patients in younger age group with private insurance who underwent treatment at a high case-volume center had the best outcomes. In older patients (≥70 years), the in-patient mortality rate decreased by 25 % whereas the adverse discharge disposition rate increased by 19 %. Patients treated at high case-volume centers and by high case-volume physicians had lower rates of in-patient mortality (P < 0.05) and adverse outcome at discharge (P = 0 < 0.05). There was a 54 % decrease in the number of hospitals performing one surgery/year through the decade. A 2 % relative decrease in mortality was observed in lowest volume hospitals. Though the highest increase in admission charges through the decade was seen in hospitals located in the north-east (165 % relative increase), the highest relative decrease in mortality and morbidity was observed in hospitals located in the mid-west and the south (67.6 and 22 % respectively).
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11060_2013_1183_MOESM1_ESM.tif
Supplementary Fig. 1A–1D depict the in-hospital mortality with respect to year of admission, age decade, primary payer status and the median household income for patients’ ZIP code (quartile)
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Supplementary Fig. 2A–D demonstrate the percentage of admissions with discharge to facilities other than home or self care with respect to year of admission, age decade, primary payer status and the median household income for patients’ ZIP code (quartile)
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Supplementary Fig. 3A–D demonstrate the trends in mortality and morbidity from 2001 to 2010 with respect to hospital (5A and 5B) and physician (5C and 5D) case volume quartiles. The 1st and 2nd physician case volume quartiles are combined and shown as ‘1’. Physician information was available uniformly for the years 2003 through 2009.
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Supplemental Fig. 4A–D show trends in case volume, in-patient mortality, and morbidity and hospital charges in the four regions of the US
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Ambekar, S., Sharma, M., Madhugiri, V.S. et al. Trends in intracranial meningioma surgery and outcome: a Nationwide Inpatient Sample database analysis from 2001 to 2010. J Neurooncol 114, 299–307 (2013). https://doi.org/10.1007/s11060-013-1183-6
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DOI: https://doi.org/10.1007/s11060-013-1183-6