Jimenez Adrian E, Chakravarti Sachiv, Liu Sophie, Wu Esther, Wei Oren, Shah Pavan P, Nair Sumil, Gendreau Julian L, Porras Jose L, Azad Tej D, Jackson Christopher M, Gallia Gary, Bettegowda Chetan, Weingart Jon, Brem Henry, Mukherjee Debraj
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2022 Mar;159:e130-e138. doi: 10.1016/j.wneu.2021.12.010. Epub 2021 Dec 8.
A need exists to better understand the prognostic factors that influence high-value care outcomes after meningioma surgery. The goal of the present study was to develop predictive models to determine the patients at risk of experiencing an extended hospital length of stay (LOS), nonroutine discharge disposition, and/or a 90-day hospital readmission after non-skull base meningioma resection.
In the present study, we analyzed the data from 396 patients who had undergone surgical resection of non-skull base meningiomas at a single institution between January 1, 2005 and December 31, 2020. The Mann-Whitney U test was used for bivariate analysis of the continuous variables and the Fisher exact test for bivariate analysis of the categorical variables. A multivariate analysis was conducted using logistic regression models.
Most patients had had a falcine or parasagittal meningioma (66.2%), with the remainder having convexity (31.8%) or intraventricular (2.0%) tumors. Nonelective surgery (P < 0.0001) and an increased tumor volume (P = 0.0022) were significantly associated with a LOS >4 days on multivariate analysis. The independent predictors of a nonroutine discharge disposition included male sex (P = 0.0090), nonmarried status (P = 0.024), nonelective surgery (P = 0.0067), tumor location within the parasagittal or intraventricular region (P = 0.0084), and an increased modified frailty index score (P = 0.039). Hospital readmission within 90 days was independently associated with nonprivate insurance (P = 0.010) and nonmarried status (P = 0.0081). Three models predicting for a prolonged LOS, nonroutine discharge disposition, and 90-day readmission were implemented in the form of an open-access, online calculator (available at: https://neurooncsurgery3.shinyapps.io/non_skull_base_meningiomas/).
After external validation, our open-access, online calculator could be useful for assessing the likelihood of adverse postoperative outcomes for patients undergoing surgery of non-skull base meningioma.
有必要更好地了解影响脑膜瘤手术后高价值医疗结局的预后因素。本研究的目的是建立预测模型，以确定非颅底脑膜瘤切除术后有延长住院时间（LOS）、非常规出院处置和/或90天内再次入院风险的患者。
在本研究中，我们分析了2005年1月1日至2020年12月31日期间在单一机构接受非颅底脑膜瘤手术切除的396例患者的数据。连续变量的双变量分析采用Mann-Whitney U检验，分类变量的双变量分析采用Fisher精确检验。使用逻辑回归模型进行多变量分析。
大多数患者患有大脑镰旁或矢状窦旁脑膜瘤（66.2%），其余患者患有凸面（31.8%）或脑室内（2.0%）肿瘤。多变量分析显示，非择期手术（P < 0.0001）和肿瘤体积增加（P = 0.0022）与住院时间>4天显著相关。非常规出院处置的独立预测因素包括男性（P = 0.0090）、未婚状态（P = 0.024）、非择期手术（P = 0.0067）、矢状窦旁或脑室内区域的肿瘤位置（P = 0.0084）以及改良虚弱指数评分增加（P = 0.039）。90天内再次入院与非私人保险（P = 0.010）和未婚状态（P = 0.0081）独立相关。以开放获取的在线计算器形式实施了三个预测延长住院时间、非常规出院处置和90天再入院的模型（可在以下网址获取：https://neurooncsurgery3.shinyapps.io/non_skull_base_meningiomas/）。
经过外部验证后，我们的开放获取在线计算器可能有助于评估接受非颅底脑膜瘤手术患者术后不良结局的可能性。
