Journal of Neuro-Oncology

, Volume 114, Issue 3, pp 299–307

Trends in intracranial meningioma surgery and outcome: a Nationwide Inpatient Sample database analysis from 2001 to 2010

  • Sudheer Ambekar
  • Mayur Sharma
  • Venkatesh S. Madhugiri
  • Anil Nanda
Clinical Study
  • 287 Downloads

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).

Keywords

Meningioma Trends Nationwide Inpatient Sample Mortality Morbidity 

Supplementary material

11060_2013_1183_MOESM1_ESM.tif (1.6 mb)
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)
11060_2013_1183_MOESM2_ESM.tif (1.6 mb)
Supplementary Fig. 2AD 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)
11060_2013_1183_MOESM3_ESM.tif (1.6 mb)
Supplementary Fig. 3AD 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.
11060_2013_1183_MOESM4_ESM.tif (1.6 mb)
Supplemental Fig. 4AD show trends in case volume, in-patient mortality, and morbidity and hospital charges in the four regions of the US
11060_2013_1183_MOESM5_ESM.docx (12 kb)
Supplementary material 5 (DOCX 12 kb)

References

  1. 1.
    Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K (2010) The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg 113:1072–1078PubMedCrossRefGoogle Scholar
  2. 2.
    Kondziolka D, Flickinger JC, Perez B (1998) Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 43:405–413; discussion 413–404Google Scholar
  3. 3.
    Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA (2003) Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys 55:1000–1005PubMedCrossRefGoogle Scholar
  4. 4.
    Nanda A, Javalkar V, Banerjee AD (2011) Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 114:1268–1277PubMedGoogle Scholar
  5. 5.
    Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, Parsa AT (2010) The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg 113:1029–1035PubMedCrossRefGoogle Scholar
  6. 6.
    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 Neurosurg 102:977–986PubMedCrossRefGoogle Scholar
  7. 7.
    HCUP Nationwide Inpatient Sample (NIS) (2001–2010) Healthcare cost and utilization project (HCUP). Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar
  8. 8.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  9. 9.
    Bateman BT, Pile-Spellman J, Gutin PH, Berman MF (2005) Meningioma resection in the elderly: nationwide inpatient sample, 1998–2002. Neurosurgery 57:866–872; discussion 866–872Google Scholar
  10. 10.
    Barker FG, 2nd, Amin-Hanjani S, Butler WE, Ogilvy CS, Carter BS(2003) In-hospital mortality and morbidity after surgical treatment of unruptured intracranial aneurysms in the United States, 1996–2000: the effect of hospital and surgeon volume. Neurosurgery 52:995–1007; discussion 1007–1009Google Scholar
  11. 11.
    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. Neurosurgery 52:48–53; discussion 53–44Google Scholar
  12. 12.
    Kalkanis SN, Eskandar EN, Carter BS, Barker FG, 2nd (2003) Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52:1251–1261; discussion 1261–1252Google Scholar
  13. 13.
    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 52:1056–1063; discussion 1063–1055Google Scholar
  14. 14.
    Solomon RA, Mayer SA, Tarmey JJ (1996) Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. Stroke 27:13–17PubMedCrossRefGoogle Scholar
  15. 15.
    Barker FG 2nd (2004) Craniotomy for the resection of metastatic brain tumors in the US, 1988–2000: decreasing mortality and the effect of provider caseload. Cancer 100:999–1007PubMedCrossRefGoogle Scholar
  16. 16.
    Barker FG 2nd, Carter BS, Ojemann RG, Jyung RW, Poe DS, McKenna MJ (2003) Surgical excision of acoustic neuroma: patient outcome and provider caseload. Laryngoscope 113:1332–1343PubMedCrossRefGoogle Scholar
  17. 17.
    Arienta C, Caroli M, Crotti F, Villani R (1990) Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir 107:47–55PubMedCrossRefGoogle Scholar
  18. 18.
    Awad IA, Kalfas I, Hahn JF, Little JR (1989) Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography. Neurosurgery 24:557–560PubMedCrossRefGoogle Scholar
  19. 19.
    Cornu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M, Philippon J (1990) Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir 102:98–102PubMedCrossRefGoogle Scholar
  20. 20.
    Djindjian M, Caron JP, Athayde AA, Fevrier MJ (1988) Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir 90:121–123PubMedCrossRefGoogle Scholar
  21. 21.
    Mastronardi L, Ferrante L, Qasho R, Ferrari V, Tatarelli R, Fortuna A (1995) Intracranial meningiomas in the 9th decade of life: a retrospective study of 17 surgical cases. Neurosurgery 36:270–274PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sudheer Ambekar
    • 1
  • Mayur Sharma
    • 1
  • Venkatesh S. Madhugiri
    • 1
  • Anil Nanda
    • 1
  1. 1.Department of NeurosurgeryLouisiana State University Health Sciences CenterShreveportUSA

Personalised recommendations