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

  • Evan M. LutherEmail author
  • David McCarthy
  • Katherine M. Berry
  • Nikhil Rajulapati
  • Ashish H. Shah
  • Daniel G. Eichberg
  • Ricardo J. Komotar
  • Michael Ivan
Clinical Study

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.

Keywords

Brain tumor Surgical neuro-oncology Craniotomy Academic centers Hospital teaching status Decreased morbidity and mortality 

Notes

Compliance with ethical standards

Conflict of interest

This study was not funded by any source and all authors declare no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Institutional Review Board (IRB) approval for the study was not necessary because all patient data with identifying information is stripped from the NIS repository.

Supplementary material

11060_2020_3395_MOESM1_ESM.docx (110 kb)
Supplementary file1 (DOCX 109 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Sylvester Comprehensive Cancer CenterUniversity of Miami Health SystemMiamiUSA

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