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Acta Neurochirurgica

, Volume 154, Issue 8, pp 1343–1350 | Cite as

The effect of centralization of caseload for primary brain tumor surgeries: trends from 2001–2007

  • Miriam Nuño
  • Debraj Mukherjee
  • Christine Carico
  • Adam Elramsisy
  • Anand Veeravagu
  • Keith L. Black
  • Chirag G. PatilEmail author
Clinical Article

Abstract

Background

Improved patient outcomes have been associated with high-caseload hospitals for a multitude of conditions. This study analyzed adult patients undergoing surgical resection or biopsy of primary brain tumors. The aim of this study is two-fold: (1) to evaluate whether the trend towards centralization of primary brain tumor care in the US has continued during the period of between 2001 and 2007, and (2) to analyze volume-outcome effects.

Methods

Surgical volume trends of adults undergoing resection/biopsy of primary supratentorial brain tumors were analyzed using the Nationwide Inpatient Sample. High- and low-caseload hospitals were defined as those performing in the highest and lowest quintile of procedures, respectively. Length of stay (LOS), mortality and discharge disposition were the main outcomes of interest.

Results

NIS estimated 124,171 patients underwent resection/biopsy of primary supratentorial brain tumors between 2001 and 2007 in the US. The average number of annual resections in the highest 2 % and lowest 25 % caseload hospitals were 322 and 12 cases, respectively. Surgeries in high-caseload hospitals increased by 137 %, while those in low-caseload centers declined by 16.0 %. Overall, mortality decreased 35 %, with a reduction of 45 % in high- (from 2.2 % to 1.2 %) and 19 % in low- (from 3.2 % to 2.6 %) caseload hospitals. High-caseload centers had lower LOS than hospitals with lower caseload centers (6.4 vs. 8.0 days, p < 0.001). Multivariate analysis showed that patients treated in low-volume hospitals had an increased risk of death (OR 1.8, CI: 1.2-2.7, p = 0.006) and adverse discharge (OR 1.4, CI: 1.1-1.7, p = 0.01).

Conclusions

Neurosurgical caseload at the nation’s high volume craniotomy centers has continued to rise disproportionately, while low-caseload centers have seen a decrease in overall surgical volume. Over the time period between 2001 and 2007 there was a trend towards improved in-hospital mortality, LOS and discharge disposition for all hospitals; however, the trend is convincingly favorable for high-caseload hospitals.

Keywords

Caseload centralization Volume-outcome relationship Primary brain tumor Craniotomy Mortality 

Notes

Acknowledgements

We thank Sherry Brandon for editorial and administrative help with this manuscript.

Conflicts of interest

None.

Funding

None.

References

  1. 1.
    Adibe OO, Nichol PF, Flake AW, Mattei P (2006) Comparison of outcomes after laparoscopic and open pyloromyotomy at a high-volume pediatric teaching hospital. J Pediatr Surg 41(10):1676–1678PubMedCrossRefGoogle Scholar
  2. 2.
    Alami RS, Morton JM, Sanchez BR, Curet MJ, Wren SM, Safadi BY (2005) Laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs and high-volume academic facilities: a comparison of institutional outcomes. Am J Surg 190(5):821–825PubMedCrossRefGoogle Scholar
  3. 3.
    Bardach NS, Zhao S, Gress DR, Lawton MT, Johnston SC (2002) Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 33(7):1851–1856PubMedCrossRefGoogle Scholar
  4. 4.
    Barker FG 2nd, Klibanski A, Swearingen BV (2003) Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 88(10):4709–4719PubMedCrossRefGoogle Scholar
  5. 5.
    Barker FG 2nd, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. J Neuro Oncol 7(1):49–63CrossRefGoogle Scholar
  6. 6.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280(20):1747–1751PubMedCrossRefGoogle Scholar
  7. 7.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349(22):2117–2127PubMedCrossRefGoogle Scholar
  8. 8.
    Black PC, Brown GA, Dinney CP (2006) Should cystectomy only be performed at high-volume hospitals by high-volume surgeons? Curr Opin Urol 16(5):344–349PubMedCrossRefGoogle Scholar
  9. 9.
    Chernov MF (2004) The impact of provider volume on mortality after intracranial tumor resection and outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. J Neurosurgery 54(4):1027–1028, author reply 1028CrossRefGoogle Scholar
  10. 10.
    Cowan JA Jr, Dimick JB, Leveque JC, Thompson BG, Upchurch GR Jr, Hoff JT (2003) The impact of provider volume on mortality after intracranial tumor resection. J Neurosurgery 52(1):48–53, discussion 53–4Google Scholar
  11. 11.
    Curry WT, McDermott MW, Carter BS, Barker FG 2nd (2005) Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurgery 102(6):977–986CrossRefGoogle Scholar
  12. 12.
    Dunkle-Blatter SE, St Jean MR, Whitehead C, Strodel W 3rd, Bennotti PN, Still C, Reed MJ, Wood CG, Petrick AT (2007) Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis 3(2):163–169, discussion 169–70PubMedCrossRefGoogle Scholar
  13. 13.
    Economou C (2010) Greece: Health system review. Health Syst Transit 12(7):1–177, xv-xviPubMedGoogle Scholar
  14. 14.
    Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36(1):8–27PubMedCrossRefGoogle Scholar
  15. 15.
    Ellis SG, Weintraub W, Holmes D, Shaw R, Block PC, King SB 3rd (1997) Relation of operator volume and experience to procedural outcome of percutaneous coronary revascularization at hospitals with high interventional volumes. Circulation 95(11):2479–2484PubMedCrossRefGoogle Scholar
  16. 16.
    Elson S (2009) Regionalization of health care from a political and structural perspective. Healthc Manage Forum 22(1):6–11, discussion 12–21, 22–37PubMedCrossRefGoogle Scholar
  17. 17.
    Guller U, Safford S, Pietrobon R, Heberer M, Oertli D, Jain NB (2005) High hospital volume is associated with better outcomes for breast cancer surgery: analysis of 233,247 patients. World J Surg 29(8):994–999, discussion 999–1000PubMedCrossRefGoogle Scholar
  18. 18.
    Harbrecht BG, Zenati MS, Alarcon LH, Ochoa JB, Puyana JC, Schuchert VD, Peitzman AB (2005) Is outcome after blunt splenic injury in adults better in high-volume trauma centers? Am Surg 71(11):942–948, discussion 948–9PubMedGoogle Scholar
  19. 19.
    Hillner BE, Smith TJ, Desch CE (2000) Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 18(11):2327–2340PubMedGoogle Scholar
  20. 20.
    Johnston SC (2000) Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. Stroke 31(1):111–117PubMedCrossRefGoogle Scholar
  21. 21.
    Long DM, Gordon T, Bowman H, Etzel A, Burleyson G, Betchen S, Garonzik IM, Brem H (2003) Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. Neurosurgery 52(5):1056–1063, discussion 1063–5PubMedCrossRefGoogle Scholar
  22. 22.
    Malenka DJ, McGrath PD, Wennberg DE, Ryan TJ Jr, Kellett MA Jr, Shubrooks SJ Jr, Bradley WA, Hettlemen BD, Robb JF, Hearne MJ, Silver TM, Walkings MW, O’Meara JR, VerLee PN, O’Rourke DJ (1999) The relationship between operator volume and outcomes after percutaneous coronary interventions in high volume hospitals in 1994–1996: the northern New England experience. Northern New England Cardiovascular Disease Study Group. J Am Coll Cardiol 34(5):1471–1480PubMedCrossRefGoogle Scholar
  23. 23.
    Meyerhardt JA, Catalano PJ, Schrag D, Ayanian JZ, Haller DG, Mayer RJ, Macdonald JS, Benson AB 3rd, Fuchs CS (2003) Association of hospital procedure volume and outcomes in patients with colon cancer at high risk for recurrence. Ann Intern Med 139(8):649–657PubMedGoogle Scholar
  24. 24.
    Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, Schrag D, Ayanian JZ, O’Connell MJ, Weeks JC, Mayer RJ, Willett CG, MacDonald JS, Benson AB 3rd, Fuchs CS (2004) Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: findings from the Intergroup 0114 Study. J Clin Oncol 22(1):166–174PubMedCrossRefGoogle Scholar
  25. 25.
    Natarajan SK, Sekhar LN, Ghodke B, Britz GW, Bhagawati D, Temkin N (2008) Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center. AJNR Am J Neuroradiol 29(4):753–759PubMedCrossRefGoogle Scholar
  26. 26.
    Politi A, Galli M, Zerboni S, Michi R, De Marco F, Llambro M, Ferrari G (2006) Operator volume and outcomes of primary angioplasty for acute myocardial infarction in a single high-volume centre. J Cardiovasc Med (Hagerstown) 7(10):761–767CrossRefGoogle Scholar
  27. 27.
    Quality of Healthcare Cost and Utilization Project (HCUP) Databases (2011) Nationwide Inpatient Sample http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 20 Dec 2011.
  28. 28.
    Saltman RB (2008) Decentralization, re-centralization and future European health policy. Eur J Public Health 18(2):104–106PubMedCrossRefGoogle Scholar
  29. 29.
    Shook TL, Sun GW, Burstein S, Eisenhauer AC, Matthews RV (1996) Comparison of percutaneous transluminal coronary angioplasty outcome and hospital costs for low-volume and high-volume operators. Am J Cardiol 77(5):331–336PubMedCrossRefGoogle Scholar
  30. 30.
    Smith ER, Butler WE, Barker FG 2nd (2004) Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 54(3):553–563, discussion 563–5PubMedCrossRefGoogle Scholar
  31. 31.
    Stephens DJ, Saunders JK, Belsley S, Trivedi A, Ewing DR, Iannace V, Capella RF, Wasielewski A, Moran S, Schmidt HJ, Ballantyne GH (2008) Short-term outcomes for super-super obese (BMI > or =60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass. Surg Obes Relat Dis 4(3):408–415PubMedCrossRefGoogle Scholar
  32. 32.
    Suhr D (2009) Paper 058–2009: Selecting a Stratified Sample with PROC SURVEYSELECT. SAS Global Forum.Google Scholar
  33. 33.
    Tediosi F, Gabriele S, Longo F (2009) Governing decentralization in health care under tough budget constraint: what can we learn from the Italian experience? Health Policy 90(2–3):303–312PubMedCrossRefGoogle Scholar
  34. 34.
    Venkatesh R, Muralikrishnan R, Balent LC, Prakash SK, Prajna NV (2005) Outcomes of high volume cataract surgeries in a developing country. Br J Ophthalmol 89(9):1079–1083PubMedCrossRefGoogle Scholar
  35. 35.
    Westin T, Stalfors J (2008) Tumour boards/multidisciplinary head and neck cancer meetings: are they of value to patients, treating staff or a political additional drain on healthcare resources? Curr Opin Otolaryngol Head Neck Surg 16(2):103–107PubMedCrossRefGoogle Scholar
  36. 36.
    Zahn R, Gottwik M, Hochadel M, Senges J, Zeymer U, Vogt A, Meinertz T, Dietz R, Hauptmann KE, Grube E, Kerber S, Sechtem U, Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK) (2008) Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Heart 94(3):329–335PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Miriam Nuño
    • 1
  • Debraj Mukherjee
    • 1
  • Christine Carico
    • 1
  • Adam Elramsisy
    • 1
  • Anand Veeravagu
    • 2
  • Keith L. Black
    • 1
  • Chirag G. Patil
    • 1
    Email author
  1. 1.Department of Neurosurgery, Cedars-Sinai Medical CenterCenter for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical InstituteLos AngelesUSA
  2. 2.Department of NeurosurgeryStanford University School of MedicineStanfordUSA

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