Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St. Suite 3300, Los Angeles, CA, 90033, USA.
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Neurooncol. 2024 Nov;170(2):437-449. doi: 10.1007/s11060-024-04800-5. Epub 2024 Sep 12.
Improved outcomes have been noted in patients undergoing malignant brain tumor resection at high-volume centers. Studies have arbitrarily chosen high-volume dichotomous cutoffs and have not evaluated volume-outcome associations at specific institutional procedural volumes. We sought to establish the continuous association of volume with patient outcomes and identify cutoffs significantly associated with mortality, major complications, and readmissions. We hypothesized that a linear volume-outcome relationship can estimate likelihood of adverse outcomes when comparing any two volumes.
The patient cohort was identified with ICD-10 coding in the Nationwide Readmissions Database(NRD). The association of volume and mortality, major complications, and 30-/90-day readmissions were evaluated in multivariate analyses. Volume was used as a continuous variable with two/three-piece splines, with various knot positions to reflect the best model performance, based on the Quasi Information Criterion(QIC).
From 2016 to 2018, 34,486 patients with malignant brain tumors underwent resection. When volume was analyzed as a continuous variable, mortality risk decreased at a steady rate of OR 0.988 per each additional procedure increase for hospitals with 1-65 cases/year(95% CI 0.982-0.993, p < 0.0001). Risk of major complications decreased from 1 to 41 cases/year(OR 0.983, 95% CI 0.979-0.988, p < 0.0001), 30-day readmissions from 1 to 24 cases/year(OR 0.987, 95% CI 0.979-0.995, p = 0.001) and 90-day readmissions from 1 to 23 cases/year(OR 0.989, 95% CI 0.983-0.995, p = 0.0003) and 24-349 cases/year(OR 0.9994, 95% CI 0.999-1, p = 0.01).
In multivariate analyses, institutional procedural volume remains linearly associated with mortality, major complications, and 30-/90-day readmission up to specific cutoffs. The resulting linear association can be used to calculate relative likelihood of adverse outcomes between any two volumes.
在高容量中心进行恶性脑肿瘤切除的患者，其结果得到了改善。研究随意选择了高容量二分截止值，并未评估特定机构程序量的容量结果关联。我们试图建立容量与患者结果的连续关联，并确定与死亡率，主要并发症和 30/90 天再入院率显著相关的截止值。我们假设线性体积-结果关系可以在比较两个体积时估计不良结果的可能性。
使用国际疾病分类第十版（ICD-10）编码在全国再入院数据库（NRD）中确定患者队列。使用多元分析评估了容量与死亡率，主要并发症和 30/90 天再入院之间的关联。根据准信息准则（QIC），基于两/三部分样条，将体积用作连续变量，并使用各种节点位置来反映最佳模型性能。
2016 年至 2018 年，34486 例恶性脑肿瘤患者接受了切除术。当将体积作为连续变量进行分析时，对于每年 1-65 例手术的医院，死亡率风险以每增加一次手术 OR 0.988 的稳定速度降低（95％CI 0.982-0.993，p <0.0001）。从每年 1 例至 41 例的主要并发症风险降低（OR 0.983，95％CI 0.979-0.988，p <0.0001），从每年 1 例至 24 例的 30 天再入院率降低（OR 0.987，95％CI 0.979-0.995，p = 0.001）和 90 天再入院率从每年 1 例至 23 例（OR 0.989，95％CI 0.983-0.995，p = 0.0003）和 24-349 例/年（OR 0.9994，95％CI 0.999-1，p = 0.01）。
在多元分析中，机构程序量与死亡率，主要并发症和 30/90 天再入院率之间仍然呈线性相关，直到达到特定的截止值。由此产生的线性关联可用于计算两个体积之间不良结果的相对可能性。
