Barker Fred G
Brain Tumor Center, Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Cancer. 2004 Mar 1;100(5):999-1007. doi: 10.1002/cncr.20058.
To assist in selecting treatment for patients with brain metastases, the current study assessed the risk of adverse outcomes after contemporary resection of metastatic brain tumors in relation to patient, surgeon, and hospital characteristics, with particular attention to the volume of care and trends in outcomes.
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.
The overall in-hospital mortality rate was 3.1% and an additional 16.7% of patients were not discharged directly home. In multivariate analyses, larger-volume centers were found to have lower mortality rates for intracranial metastasis 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.
The results of the current study found that higher-volume hospitals and surgeons provided superior short-term outcomes after resection of intracranial metastasis was performed, with shorter lengths of stay and a trend toward lower charges.
为协助选择脑转移瘤患者的治疗方案，本研究评估了当代转移性脑肿瘤切除术后不良结局的风险，该风险与患者、外科医生及医院特征相关，尤其关注治疗量和结局趋势。
对1988 - 2000年间全国住院患者样本中的13685例入院病例进行回顾性队列研究。采用多变量逻辑回归、有序回归和对数线性回归分析，以死亡率、出院转归、住院时间和总住院费用作为终点指标。
总体院内死亡率为3.1%，另有16.7%的患者未直接出院回家。在多变量分析中，发现治疗量较大的中心颅内转移瘤切除术后的死亡率较低（优势比[OR]，0.79；95%置信区间[95%CI]，0.59 - 1.03[P = 0.09]）。在治疗量较高的医院，不良出院转归的可能性也较小（OR，0.75；95%CI，0.65 - 0.86[P < 0.001]）。对于外科医生的病例量，病例量较高的医生手术死亡率较低（OR，0.49；95%CI，0.30 - 0.80[P = 0.004]），不良出院转归的发生率也显著较低（OR，0.51；95%CI，0.40 - 0.64[P < 0.001]）。在研究期间，每年的切除例数增加了79%，从1988年的3900例增至2000年的7000例。院内死亡率从1988 - 1990年的4.6%降至1997 - 2000年的2.3%，相对降幅为49%。据报道，治疗量较高的医生手术患者的住院时间显著缩短。未发现住院费用与医院病例量显著相关，且发现由病例量较高的外科医生进行手术后住院费用显著降低。
本研究结果发现，治疗量较高的医院和外科医生在进行颅内转移瘤切除术后能提供更好的短期结局，住院时间更短，且有住院费用降低的趋势。
