Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2020 Oct;142:e344-e349. doi: 10.1016/j.wneu.2020.06.239. Epub 2020 Jul 9.
Discharge disposition is an important outcome for neurosurgeons to consider in the context of high-quality, value-based care. There has been limited research into how the unique anatomic considerations associated with parasagittal/parafalcine meningioma resection may influence discharge disposition. We investigated the effects of various predictors on discharge disposition within a cohort of patients with parasagittal/parafalcine meningioma.
A total of 154 patients treated at a single institution were analyzed (2016-2019). Bivariate analysis was conducted using the Mann-Whitney U and Fisher exact tests. Multivariate analysis was conducted using logistic regression. An optimism-corrected C-statistic was calculated using 2000 bootstrap samples to assess logistic regression model performance.
Our cohort was mostly female (67.5%) and white (72.7%), with a mean age of 57.29 years. Most patients had tumors associated with the middle third of the superior sagittal sinus (SSS) (60.4%) and had tumors that were not fully occluding the SSS (74.0%). In multivariate analysis, independent predictors of nonroutine discharge disposition included 5-factor Modified Frailty Index score (odds ratio [OR], 2.06; P = 0.0088), Simpson grade IV resection (OR, 4.22; P = 0.0062), and occurrence of any postoperative complication (OR, 2.89; P = 0.031). The optimism-corrected C-statistic of our model was 0.757.
In our single-institution experience, neither extent of SSS invasion nor location along the SSS predicted nonroutine discharge, suggesting that tumor invasion and posterior location along the SSS are not necessarily contraindications to surgery. Our results also highlight the importance of frailty and tumor size in stratifying patients at risk of nonroutine discharge disposition.
在高质量、注重价值的医疗服务背景下，出院去向是神经外科医生需要考虑的重要结果。对于与矢状窦旁/蝶骨嵴脑膜瘤切除术相关的独特解剖学因素如何影响出院去向，相关研究非常有限。我们调查了一系列矢状窦旁/蝶骨嵴脑膜瘤患者中各种预测因素对出院去向的影响。
对单机构治疗的 154 例患者进行了分析（2016-2019 年）。采用 Mann-Whitney U 和 Fisher 确切检验进行了两变量分析。采用 logistic 回归进行了多变量分析。使用 2000 个 bootstrap 样本计算了经过乐观校正的 C 统计量，以评估 logistic 回归模型的性能。
我们的队列主要为女性（67.5%）和白人（72.7%），平均年龄为 57.29 岁。大多数患者的肿瘤与上矢状窦（SSS）的中三分之一有关（60.4%），且肿瘤未完全阻塞 SSS（74.0%）。在多变量分析中，非常规出院去向的独立预测因素包括 5 因素改良虚弱指数评分（优势比[OR]，2.06；P=0.0088）、Simpson 分级 IV 切除（OR，4.22；P=0.0062）和任何术后并发症的发生（OR，2.89；P=0.031）。我们模型的经过乐观校正的 C 统计量为 0.757。
在我们的单机构经验中，SSS 侵犯的程度和 SSS 上的位置均不能预测非常规出院，这表明肿瘤侵犯和 SSS 后段位置不一定是手术的禁忌症。我们的结果还强调了虚弱和肿瘤大小在分层非常规出院去向风险患者中的重要性。
