Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA.
Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
J Neurooncol. 2023 May;163(1):105-114. doi: 10.1007/s11060-023-04313-7. Epub 2023 Apr 21.
High-volume hospitals are associated with improved surgical outcomes for acoustic neuromas (ANs). Due to the benign and slow-growing nature of ANs, many patients travel to geographically distant cities, states, or countries for their treatment. However, the impact of travel burden to high-volume centers, as well as its relative benefit are poorly understood. We compared post-operative outcomes between AN patients that underwent treatment at local, low-volume hospitals with those that traveled long distances to high-volume hospitals.
The National Cancer Database was used to analyze AN patients that underwent surgery (2004-2015). Patients in the lowest quartile of travel distance and volume (Short-travel/Low-Volume: STLV) were compared to patients in the highest quartile of travel distance and volume (Long-travel/High-Volume: LTHV). Only STLV and LTHV cases were included for analysis.
Of 13,370 cases, 2,408 met inclusion criteria. STLV patients (n = 1,305) traveled a median of 6 miles (Interquartile range [IQR] 3-9) to low-volume centers (median 2, IQR 1-3 annual cases) and LTHV patients (n = 1,103) traveled a median of 143 miles [IQR 103-230, maximum 4,797] to high-volume centers (median 34, IQR 28-42 annual cases). LTHV patients had lower Charlson/Deyo scores (p = 0.001), mostly received care at academic centers (81.7% vs. 39.4%, p < 0.001), and were less likely to be minorities (7.0% vs. 24.2%, p < 0.001) or underinsured (4.2% vs. 13.8%, p < 0.001). There was no difference in average tumor size. On multivariable analysis, LTHV predicted increased likelihood of gross total resection (odds ratio [OR] 5.6, 95% confidence interval [CI] 3.8-8.4, p < 0.001), longer duration between diagnosis and surgery (OR 1.3, 95% CI 1.0-1.6, p = 0.040), decreased length of hospital stay (OR 0.5, 95% CI 0.4-0.7, p < 0.001), and greater overall survival (Hazard Ratio [HR] 0.6, 95% CI 0.4-0.95, p = 0.029). There was no significant difference in 30-day readmission on adjusted analysis.
Although traveling farther to high-volume centers was associated with greater time between diagnosis and treatment for AN patients, they experienced superior postoperative outcomes compared to patients who received treatment locally at low-volume centers. Enabling access and travel to high-volume centers may improve AN patient outcomes.
大容量医院与听神经瘤（ANs）的手术结果改善有关。由于 ANs 的良性和缓慢生长特性，许多患者前往地理位置遥远的城市、州或国家接受治疗。然而，前往大容量中心的旅行负担的影响及其相对益处还了解甚少。我们比较了在当地低容量医院接受治疗的 AN 患者与长途跋涉前往大容量医院的患者的术后结果。
国家癌症数据库用于分析接受手术的 AN 患者（2004-2015 年）。将旅行距离和体积最低四分位数（短程/低体积：STLV）的患者与旅行距离和体积最高四分位数（长途/高体积：LTHV）的患者进行比较。仅包括 STLV 和 LTHV 病例进行分析。
在 13370 例患者中，有 2408 例符合纳入标准。STLV 患者（n=1305）前往低容量中心的中位数距离为 6 英里（四分位距[IQR]3-9），前往低容量中心的中位数距离为 2，IQR 为 1-3 例/年，而 LTHV 患者（n=1103）前往高容量中心的中位数距离为 143 英里[IQR 103-230，最大 4797]，前往高容量中心的中位数距离为 34，IQR 为 28-42 例/年。LTHV 患者的 Charlson/Deyo 评分较低（p=0.001），大多在学术中心接受治疗（81.7% vs. 39.4%，p<0.001），少数民族（7.0% vs. 24.2%，p<0.001）或未保险（4.2% vs. 13.8%，p<0.001）的可能性较低。平均肿瘤大小无差异。多变量分析显示，LTHV 预测大体全切除的可能性增加（比值比[OR]5.6，95%置信区间[CI]3.8-8.4，p<0.001），诊断与手术之间的时间间隔延长（OR 1.3，95%CI 1.0-1.6，p=0.040），住院时间缩短（OR 0.5，95%CI 0.4-0.7，p<0.001），总生存率提高（HR 0.6，95%CI 0.4-0.95，p=0.029）。调整分析后，30 天再入院率无显著差异。
尽管前往大容量中心的路程较远，但对于 AN 患者来说，诊断与治疗之间的时间间隔更长，但与在当地低容量中心接受治疗的患者相比，他们的术后结果更好。使大容量中心能够获得和旅行可能会改善 AN 患者的预后。
