Several groups have demonstrated the safety of ambulatory brain biopsies, with no patients experiencing complications related to early discharge. Although they appear to be safe, the reasons factoring into the selection of patients have not been investigated. We performed a cross-sectional study involving 504 patients who underwent outpatient and 10,328 patients who underwent inpatient brain biopsies and were registered in State Ambulatory Surgery Databases and State Inpatient Databases respectively for four US States (New York, California, Florida, North Carolina). In a multivariate analysis private insurance (OR 2.45, 95 % CI, 1.85, 3.24), was significantly associated with outpatient procedures. Higher Charlson Comorbidity Index (OR 0.16, 95 % CI, 0.08, 0.32), high income (OR 0.37, 95 % CI, 0.26, 0.53), and high volume hospitals (OR 0.30, 95 % CI, 0.23, 0.39) were associated with a decreased chance of outpatient procedures. No sex, or racial disparities were observed. Institutional charges were significantly less for outpatient brain biopsies. There was no difference in the rate of 30-day postoperative readmissions among inpatient and outpatient procedures. The median charge for inpatient surgery was $51,316 as compared to $12,266 for the outpatient setting (P < 0.0001, Student’s t test). Access to ambulatory brain biopsies appears to be more common for patients with private insurance and less comorbidities, in the setting of lower volume hospitals. Further investigation is needed in the direction of mapping these disparities in resource utilization.
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We would like to thank Mr. Vasilios Georgitsis for his technical advice and expertise in troubleshooting some of the statistical software. We would also like to thank Brook Martin, Ph.D. for providing the databases for analysis.
Purzner T, Purzner J, Massicotte EM, Bernstein M (2011) Outpatient brain tumor surgery and spinal decompression: a prospective study of 1003 patients. Neurosurgery 69(1):119–126PubMedCrossRefGoogle Scholar
Bernstein M, Parrent AG (1994) Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81(2):165–168PubMedCrossRefGoogle Scholar
Taylor WA, Thomas NW, Wellings JA, Bell BA (1995) Timing of postoperative intracranial hematoma development and implications for the best use of neurosurgical intensive care. J Neurosurg 82(1):48–50PubMedCrossRefGoogle Scholar
Barnett GH, Miller DW, Weisenberger J (1999) Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases. J Neurosurg 91(4):569–576PubMedCrossRefGoogle Scholar
Cabantog AM, Bernstein M (1994) Complications of first craniotomy for intra-axial brain tumour. Can J Neurol Sci 21(3):213–218PubMedGoogle Scholar
Kulkarni AV, Guha A, Lozano A, Bernstein M (1998) Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy. J Neurosurg 89(1):31–35PubMedCrossRefGoogle Scholar
Sawaya R, Hammoud M, Schoppa D et al (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055PubMedCrossRefGoogle Scholar
Bernstein M (2001) Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients. Can J Neurol Sci 28(2):120–124PubMedGoogle Scholar
Bhardwaj RD, Bernstein M (2002) Prospective feasibility study of outpatient stereotactic brain lesion biopsy. Neurosurgery 51(2):358–361PubMedGoogle Scholar
Blanshard HJ, Chung F, Manninen PH, Taylor MD, Bernstein M (2001) Awake craniotomy for removal of intracranial tumor: considerations for early discharge. Anesth Analg 92(1):89–94PubMedCrossRefGoogle Scholar
Boulton M, Bernstein M (2008) Outpatient brain tumor surgery: innovation in surgical neurooncology. J Neurosurg 108(4):649–654PubMedCrossRefGoogle Scholar
Grundy PL, Weidmann C, Bernstein M (2008) Day-case neurosurgery for brain tumours: the early United Kingdom experience. Br J Neurosurg 22(3):360–367PubMedCrossRefGoogle Scholar
Khu KJ, Doglietto F, Radovanovic I et al (2010) Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study. J Neurosurg 112(5):1056–1060PubMedCrossRefGoogle Scholar
Charlson ME, Ales KL, Simon R, MacKenzie CR (1987) Why predictive indexes perform less well in validation studies. Is it magic or methods? Arch Intern Med 147(12):2155–2161PubMedCrossRefGoogle Scholar
Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46(10):1075–1090PubMedCrossRefGoogle Scholar
Calland JF, Tanaka K, Foley E et al (2001) Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway. Ann Surg 233(5):704–715PubMedCentralPubMedCrossRefGoogle Scholar
Baker GR, Norton PG, Flintoft V et al (2004) The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 170(11):1678–1686PubMedCentralPubMedCrossRefGoogle Scholar
Kaakaji W, Barnett G, Bernhard D, Warbel A, Valaitis K, Stamp S (2001) Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy. J Neurosurg 94(6):892–898PubMedCrossRefGoogle Scholar
Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why summary comorbidity measures such as the charlson comorbidity index and elixhauser score work. Med Care; 2013 May 23. [Epub ahead of print]Google Scholar