Jane S. Han, Talia Wenger, Alexandra N. Demetriou, Jonathan Dallas, Li Ding, Gabriel Zada, William J. Mack, Frank J. Attenello
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We hypothesized that a linear volume-outcome relationship can estimate likelihood of adverse outcomes when comparing any two volumes.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The patient cohort was identified with ICD-10 coding in the Nationwide Readmissions Database(NRD). The association of volume and mortality, major complications, and 30-/90-day readmissions were evaluated in multivariate analyses. Volume was used as a continuous variable with two/three-piece splines, with various knot positions to reflect the best model performance, based on the Quasi Information Criterion(QIC).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>From 2016 to 2018, 34,486 patients with malignant brain tumors underwent resection. When volume was analyzed as a continuous variable, mortality risk decreased at a steady rate of OR 0.988 per each additional procedure increase for hospitals with 1–65 cases/year(95% CI 0.982–0.993, p < 0.0001). Risk of major complications decreased from 1 to 41 cases/year(OR 0.983, 95% CI 0.979–0.988, p < 0.0001), 30-day readmissions from 1 to 24 cases/year(OR 0.987, 95% CI 0.979–0.995, p = 0.001) and 90-day readmissions from 1 to 23 cases/year(OR 0.989, 95% CI 0.983–0.995, p = 0.0003) and 24–349 cases/year(OR 0.9994, 95% CI 0.999–1, p = 0.01).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In multivariate analyses, institutional procedural volume remains linearly associated with mortality, major complications, and 30-/90-day readmission up to specific cutoffs. The resulting linear association can be used to calculate relative likelihood of adverse outcomes between any two volumes.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Procedural volume is linearly associated with mortality, major complications, and readmissions in patients undergoing malignant brain tumor resection\",\"authors\":\"Jane S. Han, Talia Wenger, Alexandra N. Demetriou, Jonathan Dallas, Li Ding, Gabriel Zada, William J. Mack, Frank J. Attenello\",\"doi\":\"10.1007/s11060-024-04800-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Purpose</h3><p>Improved outcomes have been noted in patients undergoing malignant brain tumor resection at high-volume centers. Studies have arbitrarily chosen high-volume dichotomous cutoffs and have not evaluated volume-outcome associations at specific institutional procedural volumes. We sought to establish the continuous association of volume with patient outcomes and identify cutoffs significantly associated with mortality, major complications, and readmissions. We hypothesized that a linear volume-outcome relationship can estimate likelihood of adverse outcomes when comparing any two volumes.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>The patient cohort was identified with ICD-10 coding in the Nationwide Readmissions Database(NRD). The association of volume and mortality, major complications, and 30-/90-day readmissions were evaluated in multivariate analyses. Volume was used as a continuous variable with two/three-piece splines, with various knot positions to reflect the best model performance, based on the Quasi Information Criterion(QIC).</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>From 2016 to 2018, 34,486 patients with malignant brain tumors underwent resection. When volume was analyzed as a continuous variable, mortality risk decreased at a steady rate of OR 0.988 per each additional procedure increase for hospitals with 1–65 cases/year(95% CI 0.982–0.993, p < 0.0001). Risk of major complications decreased from 1 to 41 cases/year(OR 0.983, 95% CI 0.979–0.988, p < 0.0001), 30-day readmissions from 1 to 24 cases/year(OR 0.987, 95% CI 0.979–0.995, p = 0.001) and 90-day readmissions from 1 to 23 cases/year(OR 0.989, 95% CI 0.983–0.995, p = 0.0003) and 24–349 cases/year(OR 0.9994, 95% CI 0.999–1, p = 0.01).</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusion</h3><p>In multivariate analyses, institutional procedural volume remains linearly associated with mortality, major complications, and 30-/90-day readmission up to specific cutoffs. 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引用次数: 0
摘要
目的人们注意到,在高手术量中心接受恶性脑肿瘤切除术的患者治疗效果更好。研究随意选择了高手术量的二分临界值,而没有评估特定机构手术量下的手术量与预后之间的关系。我们试图确定手术量与患者预后的连续关系,并确定与死亡率、主要并发症和再入院率显著相关的临界值。我们假设,在比较任何两个手术量时,线性的手术量-结果关系可以估计不良后果的可能性。多变量分析评估了容量与死亡率、主要并发症和30/90天再入院率之间的关系。根据准信息标准(QIC),将体积作为连续变量,使用两片/三片样条,并采用不同的结点位置来反映最佳模型性能。结果从2016年到2018年,共有34486名恶性脑肿瘤患者接受了切除手术。将手术量作为连续变量进行分析时,手术量为 1-65 例/年的医院,每增加 1 例手术,死亡风险以 OR 0.988 的稳定速率下降(95% CI 0.982-0.993, p <0.0001)。主要并发症风险从 1 例/年降至 41 例/年(OR 0.983,95% CI 0.979-0.988,p <0.0001),30 天再入院风险从 1 例/年降至 24 例/年(OR 0.987,95% CI 0.979-0.995,p = 0.001),90 天再入院风险从 1 例/年降至 23 例/年(OR 0.989,95% CI 0.结论在多变量分析中,机构手术量与死亡率、主要并发症和 30/90 天再入院率呈线性相关,直至特定的临界值。由此得出的线性关系可用于计算任何两个手术量之间出现不良后果的相对可能性。
Procedural volume is linearly associated with mortality, major complications, and readmissions in patients undergoing malignant brain tumor resection
Purpose
Improved outcomes have been noted in patients undergoing malignant brain tumor resection at high-volume centers. Studies have arbitrarily chosen high-volume dichotomous cutoffs and have not evaluated volume-outcome associations at specific institutional procedural volumes. We sought to establish the continuous association of volume with patient outcomes and identify cutoffs significantly associated with mortality, major complications, and readmissions. We hypothesized that a linear volume-outcome relationship can estimate likelihood of adverse outcomes when comparing any two volumes.
Methods
The patient cohort was identified with ICD-10 coding in the Nationwide Readmissions Database(NRD). The association of volume and mortality, major complications, and 30-/90-day readmissions were evaluated in multivariate analyses. Volume was used as a continuous variable with two/three-piece splines, with various knot positions to reflect the best model performance, based on the Quasi Information Criterion(QIC).
Results
From 2016 to 2018, 34,486 patients with malignant brain tumors underwent resection. When volume was analyzed as a continuous variable, mortality risk decreased at a steady rate of OR 0.988 per each additional procedure increase for hospitals with 1–65 cases/year(95% CI 0.982–0.993, p < 0.0001). Risk of major complications decreased from 1 to 41 cases/year(OR 0.983, 95% CI 0.979–0.988, p < 0.0001), 30-day readmissions from 1 to 24 cases/year(OR 0.987, 95% CI 0.979–0.995, p = 0.001) and 90-day readmissions from 1 to 23 cases/year(OR 0.989, 95% CI 0.983–0.995, p = 0.0003) and 24–349 cases/year(OR 0.9994, 95% CI 0.999–1, p = 0.01).
Conclusion
In multivariate analyses, institutional procedural volume remains linearly associated with mortality, major complications, and 30-/90-day readmission up to specific cutoffs. The resulting linear association can be used to calculate relative likelihood of adverse outcomes between any two volumes.
期刊介绍:
The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.