Is Hospital Volume a Determinant for Improved Outcomes in Meningioma Surgery? An Analysis Across New York State

Background Little information exists on the impact of hospital surgical volume on outcomes of intracranial meningioma resection. We sought to assess the association of: readmission, mortality, and length of stay following surgery for intracranial meningiomas with the procedure-specific volume of medical centers.

Methods Records of patients who underwent surgical intervention for meningiomas between 1995 and 2015 were obtained from the New York State Statewide Planning and Research Cooperative System (SPARCS) database. Information on patient and hospital characteristics were collected. Hospitals were classified into high (76th–100th percentile), medium (26th–75th percentile), and low volume (0th–25th percentile) centers by annual caseload. Outcomes of interest were mortality within 30 days, readmissions with 30 days, and prolonged length of stay. Prolonged length of stay was defined as more than 10 days. Multivariate logistic regression analysis, adjusting for patient and hospital characteristics, was used to assess the impact of surgical volume on outcomes following surgery.

Results A total of 14,239 patients underwent surgery for meningioma from 1995 to 2015; 10,252 (72%) cases were treated at a high-volume hospital. Medium- and low-volume hospitals accounted for 3,294 (23.1%) and 693 (4.9%) cases, respectively. Readmission rates at high-, medium-, and low-volume facilities were 11.8, 10.4, and 9.2%, respectively (p = 0.013). Mortality rates at high-, medium-, and low-volume hospitals were 4.3, 3.6, and 1.4%, respectively (p < 0.001). After adjustment for confounders including patient and hospital characteristics, the rate of readmission within 30 days after surgery was not statistically different for high- (p = 0.31) and medium (p = 0.49)-volume hospitals compared with low-volume hospitals. High-volume hospitals had significantly lower rates of mortality within 30 days compared with low-volume hospitals (OR = 0.393, CI: 0.253–0.612, p < 0.001). The 30-day mortality rates did not significantly differ for medium-volume hospitals. Patients at high- (OR = 0.56, CI: 0.47–0.66, p < 0.001) and medium (OR = 0.81, CI: 0.68–0.98, p = 0.026)-volume hospitals were also less likely to have a prolonged length of stay.

Conclusion Lower volume hospitals are associated with statistically significant higher rates of mortality and longer hospital stays. Although most meningioma patients were treated at high-volume centers, there are still a significant proportion of patients who undergo surgery at medium- and low-volume centers. A specialized high-volume meningioma medical center may offer improved patient outcomes, as well as help consolidate the delivery of complex medical care.

Die Autoren geben an, dass kein Interessenkonflikt besteht.