Can Currently Suggested Quality Indicators Be Transferred to Meningioma Surgery?—A Single-Center Pilot Study

Abstract

Background Risk stratification based on standardized quality measures has become crucial in neurosurgery. Contemporary quality indicators have often been developed for a wide range of neurosurgical procedures collectively. The accuracy of tumor-inherent characteristics of patients diagnosed with meningioma remains questionable. The objective of this study was the analysis of currently applied quality indicators in meningioma surgery and the identification of potential new measures.

Methods Data of 133 patients who were operated on due to intracranial meningiomas were subjected to a retrospective analysis. The primary outcomes of interest were classical quality indicators such as the 30-day readmission, 30-day reoperation, 30-day mortality, 30-day nosocomial infection, and the 30-day surgical site infection rate. Uni- and multivariate analyses were performed. The occurrence of a new postoperative neurologic deficit was analyzed as a potential new quality indicator.

Results The overall unplanned readmission rate was 3.8%; 13 patients were reoperated within 30 days (9.8%). The 30-day nosocomial infection and surgical site infection rates were 6.8 and 1.5%, respectively. A postoperative new neurologic deficit or neurologic deterioration as a currently assessed quality feature was observed in 12 patients (9.2%). The edema volume on preoperative scans proved to have a significant impact on the occurrence of a new postoperative neurologic deficit (p = 0.023).

Conclusions Classical quality indicators in neurosurgery have proved to correlate with considerable deterioration of the patient's health in meningioma surgery and thus should be taken into consideration for application in meningioma patients. The occurrence of a new postoperative neurologic deficit is common and procedure specific. Thus, this should be elucidated for application as a complementary quality indicator in meningioma surgery.

Keywords

meningioma - microsurgery - new neurologic deficit - outcome - quality indicators

^* These authors contributed equally.

Publikationsverlauf

Eingereicht: 15. Februar 2022

Angenommen: 21. Juli 2022

Accepted Manuscript online:
28. Juli 2022

Artikel online veröffentlicht:
09. Dezember 2022

• References

• 1 Ostrom QT, Patil N, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: primary brain and other central nervous system tumors diagnosed in the United States in 2013-2017. Neuro-oncol 2020; 22 (12, Suppl 2): iv1-iv96
• 2 Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol 2010; 99 (03) 307-314
• 3 Zhao L, Zhao W, Hou Y. et al. An overview of managements in meningiomas. Front Oncol 2020; 10: 1523
• 4 Lohmann S, Brix T, Varghese J. et al. Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors. J Neurosurg 2020; 134 (03) 1226-1236
• 5 Schipmann S, Varghese J, Brix T. et al. Establishing risk-adjusted quality indicators in surgery using administrative data-an example from neurosurgery. Acta Neurochir (Wien) 2019; 161 (06) 1057-1065
• 6 Kim DH, Morales M, Tai R. et al. Quality programs in neurosurgery: the Memorial Hermann/University of Texas Experience. Neurosurgery 2017; 80 (4S): S65-S74
• 7 Schipmann S, Schwake M, Suero Molina E. et al. Quality indicators in cranial neurosurgery: which are presently substantiated? A systematic review. World Neurosurg 2017; 104: 104-112
• 8 Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med 2013; 368 (13) 1175-1177
• 9 McLaughlin N, Jin P, Martin NA. Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement. J Neurosurg 2015; 123 (01) 198-205
• 10 Shah MN, Stoev IT, Sanford DE. et al. Are readmission rates on a neurosurgical service indicators of quality of care?. J Neurosurg 2013; 119 (04) 1043-1049
• 11 Dasenbrock HH, Yan SC, Chavakula V. et al. Unplanned reoperation after craniotomy for tumor: a national surgical quality improvement program analysis. Neurosurgery 2017; 81 (05) 761-771
• 12 Schipmann S, Varghese J, Brix T. et al. Establishing risk-adjusted quality indicators in surgery using administrative data-an example from neurosurgery. Acta Neurochir (Wien) 2019; 161 (06) 1057-1065
• 13 Suero Molina E, Schildmacher C, Doods J. et al. The rise of quality indicators in neurosurgery: 30-day unplanned reoperation rate evaluated in 3760 patients: a single-center experience. Acta Neurochir (Wien) 2020; 162 (01) 147-156
• 14 Lemée JM, Corniola MV, Da Broi M, Schaller K, Meling TR. Early postoperative complications in meningioma: predictive factors and impact on outcome. World Neurosurg 2019; 128: e851-e858
• 15 Gerlach R, Raabe A, Scharrer I, Meixensberger J, Seifert V. Post-operative hematoma after surgery for intracranial meningiomas: causes, avoidable risk factors and clinical outcome. Neurol Res 2004; 26 (01) 61-66
• 16 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (01) 22-39
• 17 Weir CB, Jan A. BMI Classification Percentile and Cut Off Points. Treasure Island, FL: StatPearls; 2021
• 18 Oken MM, Creech RH, Tormey DC. et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5 (06) 649-655
• 19 Doyle DJ, Goyal A, Bansal P. et al. American Society of Anesthesiologists Classification. Treasure Island, FL: StatPearls; 2021
• 20 Louis DN, Perry A, Reifenberger G. et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016; 131 (06) 803-820
• 21 Adeli A, Hess K, Mawrin C. et al. Prediction of brain invasion in patients with meningiomas using preoperative magnetic resonance imaging. Oncotarget 2018; 9 (89) 35974-35982
• 22 Hess K, Spille DC, Adeli A. et al. Brain invasion and the risk of seizures in patients with meningioma. J Neurosurg 2018; 130 (03) 789-796
• 23 Osawa T, Tosaka M, Nagaishi M, Yoshimoto Y. Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema. J Neurooncol 2013; 111 (01) 49-57
• 24 Tamiya T, Ono Y, Matsumoto K, Ohmoto T. Peritumoral brain edema in intracranial meningiomas: effects of radiological and histological factors. Neurosurgery 2001; 49 (05) 1046-1051 , discussion 1051–1052
• 25 Meling TR, Da Broi M, Scheie D, Helseth E, Smoll NR. Meningioma surgery: are we making progress?. World Neurosurg 2019; 125: e205-e213
• 26 Solheim O, Torsteinsen M, Johannesen TB, Jakola AS. Effects of cerebral magnetic resonance imaging in outpatients on observed incidence of intracranial tumors and patient survival: a national observational study. J Neurosurg 2014; 120 (04) 827-832
• 27 Schipmann S, Brix T, Varghese J. et al. Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics. Acta Neurochir (Wien) 2019; 161 (02) 287-306
• 28 Dasenbrock HH, Angriman F, Smith TR. et al. Readmission after aneurysmal subarachnoid hemorrhage: a nationwide readmission database analysis. Stroke 2017; 48 (09) 2383-2390
• 29 Dasenbrock HH, Smith TR, Rudy RF, Gormley WB, Aziz-Sultan MA, Du R. Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis. J Neurosurg 2018; 128 (03) 756-767
• 30 McCutcheon BA, Ubl DS, Babu M. et al. Predictors of surgical site infection following craniotomy for intracranial neoplasms: an analysis of prospectively collected data in the American College of Surgeons National Surgical Quality Improvement Program Database. World Neurosurg 2016; 88: 350-358
• 31 Schipmann S, Akalin E, Doods J, Ewelt C, Stummer W, Suero Molina E. When the infection hits the wound: matched case-control study in a neurosurgical patient collective including systematic literature review and risk factors analysis. World Neurosurg 2016; 95: 178-189
• 32 Schipmann S, Suero Molina E, Windheuser J. et al. The 30-day readmission rate in neurosurgery: a useful indicator for quality assessment?. Acta Neurochir (Wien) 2020; 162 (11) 2659-2669
• 33 Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360 (14) 1418-1428
• 34 Buchanan CC, Hernandez EA, Anderson JM. et al. Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement. J Neurosurg 2014; 121 (01) 170-175
• 35 Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 2013; 369 (12) 1134-1142
• 36 Dharmarajan K, Hsieh AF, Lin Z. et al. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ 2013; 347: f6571
• 37 Connolly ID, Cole T, Veeravagu A, Popat R, Ratliff J, Li G. Craniotomy for resection of meningioma: an age-stratified analysis of the MarketScan Longitudinal Database. World Neurosurg 2015; 84 (06) 1864-1870
• 38 McKee SP, Yang A, Gray M. et al. Intracranial meningioma surgery: value-based care determinants in New York State, 1995-2015. World Neurosurg 2018; 118: e731-e744
• 39 Aghi MK, Eskandar EN, Carter BS, Curry Jr WT, Barker II FG. Increased prevalence of obesity and obesity-related postoperative complications in male patients with meningiomas. Neurosurgery 2007; 61 (04) 754-760 , discussion 760–761
• 40 Lin M, Min E, Orloff EA. et al. Predictors of readmission after craniotomy for meningioma resection: a nationwide readmission database analysis. Acta Neurochir (Wien) 2020; 162 (11) 2637-2646
• 41 Ambekar S, Sharma M, Madhugiri VS, Nanda A. Trends in intracranial meningioma surgery and outcome: a Nationwide Inpatient Sample database analysis from 2001 to 2010. J Neurooncol 2013; 114 (03) 299-307
• 42 Nunno A, Li Y, Pieters TA. et al. Risk factors and associated complications of symptomatic venous thromboembolism in patients with craniotomy for meningioma. World Neurosurg 2019; 122: e1505-e1510
• 43 Dasenbrock HH, Yan SC, Smith TR. et al. Readmission after craniotomy for tumor: a national surgical quality improvement program analysis. Neurosurgery 2017; 80 (04) 551-562
• 44 Adams OE, Cruz SA, Balach T, Dirschl DR, Shi LL, Lee MJ. Do 30-day reoperation rates adequately measure quality in orthopedic surgery?. Jt Comm J Qual Patient Saf 2020; 46 (02) 72-80
• 45 Li A, Zhu H, Zhou H. et al. Unplanned surgical reoperations as a quality indicator in pediatric tertiary general surgical specialties: associated risk factors and hospitalization, a retrospective case-control analysis. Medicine (Baltimore) 2020; 99 (19) e19982
• 46 Wadhwa RK, Ohya J, Vogel TD. et al. Risk factors for 30-day reoperation and 3-month readmission: analysis from the Quality and Outcomes Database lumbar spine registry. J Neurosurg Spine 2017; 27 (02) 131-136
• 47 Corell A, Thurin E, Skoglund T. et al. Neurosurgical treatment and outcome patterns of meningioma in Sweden: a nationwide registry-based study. Acta Neurochir (Wien) 2019; 161 (02) 333-341
• 48 Kwinta BM, Krzyżewski RM, Kliś KM. et al. Predictive factors of complications post intracranial meningioma surgery leading to early unplanned reoperations - a single center study. Folia Med Cracov 2018; 58 (02) 5-13
• 49 Moghavem N, Morrison D, Ratliff JK, Hernandez-Boussard T. Cranial neurosurgical 30-day readmissions by clinical indication. J Neurosurg 2015; 123 (01) 189-197
• 50 Hoefnagel D, Kwee LE, van Putten EH, Kros JM, Dirven CM, Dammers R. The incidence of postoperative thromboembolic complications following surgical resection of intracranial meningioma. A retrospective study of a large single center patient cohort. Clin Neurol Neurosurg 2014; 123: 150-154
• 51 Lassen B, Helseth E, Rønning P. et al. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 2011; 68 (05) 1259-1268 , discussion 1268–1269
• 52 Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 1994; 35 (06) 1061-1064 , discussion 1064–1065
• 53 Morris AM, Baldwin LM, Matthews B. et al. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 2007; 245 (01) 73-79
• 54 Pucciarelli S, Chiappetta A, Giacomazzo G. et al. Surgical unit volume and 30-day reoperation rate following primary resection for colorectal cancer in the Veneto Region (Italy). Tech Coloproctol 2016; 20 (01) 31-40
• 55 O'Keeffe AB, Lawrence T, Bojanic S. Oxford craniotomy infections database: a cost analysis of craniotomy infection. Br J Neurosurg 2012; 26 (02) 265-269
• 56 Sanai N, Sughrue ME, Shangari G, Chung K, Berger MS, McDermott MW. Risk profile associated with convexity meningioma resection in the modern neurosurgical era. J Neurosurg 2010; 112 (05) 913-919
• 57 Black P, Kathiresan S, Chung W. Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 1998; 140 (10) 1013-1016 , discussion 1016–1017
• 58 Lonjaret L, Guyonnet M, Berard E. et al. Postoperative complications after craniotomy for brain tumor surgery. Anaesth Crit Care Pain Med 2017; 36 (04) 213-218
• 59 van Alkemade H, de Leau M, Dieleman EM. et al. Impaired survival and long-term neurological problems in benign meningioma. Neuro-oncol 2012; 14 (05) 658-666
• 60 Simis A, Pires de Aguiar PH, Leite CC, Santana Jr PA, Rosemberg S, Teixeira MJ. Peritumoral brain edema in benign meningiomas: correlation with clinical, radiologic, and surgical factors and possible role on recurrence. Surg Neurol 2008; 70 (05) 471-477 , discussion 477
• 61 Benz LS, Wrensch MR, Schildkraut JM. et al. Quality of life after surgery for intracranial meningioma. Cancer 2018; 124 (01) 161-166
• 62 Solheim O, Jakola AS. Quality of life outcomes in meningioma surgery. Handb Clin Neurol 2020; 170: 311-321