Craniotomy for the resection of metastatic XXXX in the U.S., 1988-2000: decreasing mortality and the effect of provider caseload.

@entity1 @entity3 @entity1313
BACKGROUND: To assist in selecting treatment for @entity1 with brain metastases, the current study assessed the risk of adverse outcomes after contemporary resection of metastatic @entity1313 in relation to @entity1 , surgeon, and hospital characteristics, with particular attention to the volume of care and trends in outcomes. METHODS: A retrospective cohort study of 13,685 admissions from the Nationwide Inpatient Sample between 1988-2000 was performed. Multivariate logistic, ordinal, and loglinear regression were used with endpoints of mortality, discharge disposition, length of stay, and total hospital charges. RESULTS: The overall in-hospital mortality rate was 3.1% and an additional 16.7% of @entity1 were not discharged directly home. In multivariate analyses, larger-volume centers were found to have lower mortality rates for intracranial @entity3 resection (odds ratio [OR], 0.79; 95% confidence interval [95% CI], 0.59-1.03 [P = 0.09]). An adverse discharge disposition also was less likely at higher-volume hospitals (OR, 0.75; 95% CI, 0.65-0.86 [P < 0.001]). For surgeon caseload, mortality was lower with higher-caseload providers (OR, 0.49; 95% CI, 0.30-0.80 [P = 0.004]) and an adverse discharge disposition occurred significantly less frequently (OR, 0.51; 95% CI, 0.40-0.64 [P < 0.001]). The annual number of resections increased by 79% during the study period, from 3900 (1988) to 7000 (2000). In-hospital mortality rates decreased from 4.6% (1988-1990) to 2.3% (1997-2000), a 49% relative decrease. Length of stay was reported to be significantly shorter with higher-volume providers. Hospital charges were not found to be associated significantly with hospital caseload and were found to be significantly lower after surgery that was performed by higher-caseload surgeons. CONCLUSIONS: The results of the current study found that higher-volume hospitals and surgeons provided superior short-term outcomes after resection of intracranial @entity3 was performed, with shorter lengths of stay and a trend toward lower charges.
