Ependymomas: surgeon case volume and patient outcomes

Abstract Aims Ependymomas (tumours arising from ependymal cells) are rare in the adult population and therefore there is limited class 1 evidence on the treatment and management of these patients. We present our experience from a large single center. We address whether management should be undertaken by sub-specialised surgeons with high volume experience. Method Retrospective comparative study. Results High volume surgeons operated on larger volume (16.14 mm3, 8.31mm3, p=0.10) and more complex tumours (multi-centric cases p=0.10). We find a non-significant improvement in complication rate (p=0.77), extent of gross total resection (70.8% against 65.7%) and a positive change in performance status for high volume surgeons (p=0.84). Length of hospital stay is significantly prolonged when complications occur (14.2 and 48.4 days, p<0.05). Conclusion Surgeons who have higher case load of ependymomas operate on more complex tumours. In addition, our results indicate there is a technical advantage of high volume surgeons compared to low volume surgeons, which translates into improved clinical outcomes for patients. We show that this has a significant impact on length of hospital stay, as well as the associated economical implications. For rare tumours such as ependymomas, super-specialisation and referral to surgeons with higher case volume will likely improve patient outcomes. We call for a multi-centre, prospective studies to combine data in demonstrating statistical significance (power calculation for complication rate, N=150, p=0.05).

Download Full-text

P199 IS ROUTINE ICU ADMISSION NECESSARY AFTER TRANSTHORACIC ESOPHAGECTOMY FOR ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCER?

Diseases of the Esophagus ◽

10.1093/dote/doz092.199 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Andrea Pansa ◽

Roit Anna Da ◽

Silvia Basato ◽

Damiano Gentile ◽

Pietro Riva ◽

...

Keyword(s):

Hospital Stay ◽

Complication Rate ◽

Esophagogastric Junction ◽

Length Of Hospital Stay ◽

High Volume ◽

Type I ◽

Transthoracic Esophagectomy ◽

Short Term ◽

Icu Admission ◽

Esophagogastric Junction Cancer

Abstract Aim We evaluated short-term outcomes of esophagectomy for esophageal and esophagogastric carcinoma without routine postoperative admission to Intensive Care Unit (ICU). Background & Methods esophagectomy is subject to high rates of complications and mortality even when performed in high-volume centers and conventional postoperative management often involves routine ICU admission according to recent guidelines and recommendations1 . From January 2018 to June 2019 a total of 112 esophagectomies were performed in the Upper GI Surgery division of Humanitas Research Hospital. We included the 83 patients that underwent transthoracic esophagectomy with a hybrid technique (laparoscopy + right thoracotomy) and high intrathoracic anastomosis for esophageal and esophagogastric junction cancer. Preoperative assessment included a prehabilitation program (nutritional evaluation, respiratory physiotherapy and adjustment of cardiologic therapy). Postoperatively, patients were managed by surgical team members. We retrospectively recorded data on necessity of ICU, operative times, complication rate (according to ECCG)2,3, length of hospital stay, in-hospital, 30-day and 90-day mortality. Results 68 patients were males and 15 females. Mean age was 65 years old (range 29-82). 67 patients underwent neoadjuvant therapy (49 chemo-radiotherapy, 18 chemotherapy alone). Postoperative ICU admission was necessary in 6 patients (9,5%), reasons for admission were necessity of ventilatory weaning in 2 patients, high lactate levels in one patient, glottic oedema following oro-tracheal intubation in one patient, while in the other cases ICU admission was planned for severe comorbidities. Mean duration of prehabilitation was 20.3 days (1-107). Mean surgery duration was 452.4 minutes (337-549). Overall complication rate was 33.8%, with the most common complications being atrial fibrillation (50% of all complications) and urinary retention (20%). There were two type I anastomotic leaks. Median length of hospital stay was 11 days (range 8-29). All patients were alive at 30 and 90 days after surgery. Conclusion routine ICU admission is not necessary after transthoracic esophagectomy for cancer in over 90% of patients. Careful patients’ evaluation, stratification of the surgical risk and systematic use of a prehabilitation program, along with adequate peri-operative management, can narrow the need for postoperative ICU admission in the setting of a high-volume centre without any impact on short-term outcomes.

Download Full-text

Travel Burden and the Direct Medical Costs of Urologic Surgery

Journal of Health Economics and Outcomes Research ◽

10.36469/9825 ◽

2016 ◽

Vol 4 (1) ◽

pp. 47-54

Author(s):

Daniel J. Olson ◽

John L. Gore ◽

Kenn B. Daratha ◽

Kenneth P. Roberts

Keyword(s):

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

High Volume ◽

Medical Costs ◽

Urologic Surgery ◽

Significant Difference ◽

Hospitalization Costs ◽

To Receive ◽

Travel Burden

Background: Increased surgical volume is associated with better patient outcomes and shorter lengths of hospitalization. As a consequence, traveling to receive care from a high volume provider may be associated with better outcomes. However, travel may also be associated with a decision by the healthcare provider to increase the length of stay due to a decreased ability to return to the primary hospital should complications arise. Thus, research is needed to understand the relationship between the distance a patient must travel and their outcomes following urologic surgery. Objective: The purpose of this study was to determine whether the distance a patient travels to receive urologic surgery is associated with their length of hospital stay and direct medical hospitalization costs. Methods: This was a retrospective observational cohort study of 12 106 patients over 50 years of age undergoing transurethral resection of the prostate (TURP), radical prostatectomy (RP) or radical cystectomy (RC) in Washington State hospitals between 2009 and 2013. Distance traveled was determined by calculating the linear distance between zip code centroids of patient residence and the hospital performing their procedure. Patients were sorted into four groups classified by distance traveled (≤5 miles, 6-20 miles, 21-50 miles and ≥51 miles) and cost calculated using a charges-to-reimbursement ratio for each hospital. Statistical significance was determined using a Kruskal-Wallis test. Results: Patients traveling greater distances had significantly lower median medical costs compared with patients who lived closer to the hospitals where they underwent TURP and RP (TURP: ≤5 miles, $6243 and ≥51 miles, $5105, p≤0.001; RP: ≤5 miles, $12 407 and ≥51 miles, $11 882, p≤0.001), whereas there was no significant difference for patients undergoing RC (≤5 miles, $27 554 and ≥51 miles, $26 761, p=0.17). Likewise, patients traveling greater distances had significantly lower median lengths of hospitalization for TURP and RP (TURP: p≤0.001, RP: p≤0.001), while there was no difference for RC (p=0.50). Conclusions: Patient travel burden does appear to play a role in cost and length of hospital stay for select urologic procedures with variable levels of morbidity and recovery time. Although these findings are statistically significant, the magnitude of the effect is small.

Download Full-text

Robot-assisted unicompartmental knee arthroplasty for patients with isolated medial compartment osteoarthritis is cost-effective

The Bone & Joint Journal ◽

10.1302/0301-620x.101b9.bjj-2018-1658.r1 ◽

2019 ◽

Vol 101-B (9) ◽

pp. 1063-1070 ◽

Cited By ~ 17

Author(s):

Nick D. Clement ◽

David J. Deehan ◽

James T. Patton

Keyword(s):

Hospital Stay ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Cost Effective ◽

High Volume ◽

Medial Compartment ◽

Case Volume ◽

Unicompartmental Knee ◽

The Cost

Aims The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY. Patients and Methods A Markov decision analysis was performed, using known parameters for costs, outcomes, implant survival, and mortality, to assess the cost-effectiveness of rUKA relative to manual TKA and UKA for patients with isolated medial compartment OA of the knee with a mean age of 65 years. The influence of case volume and shorter hospital stay were assessed. Results Using a model with an annual case volume of 100 patients, the cost per QALY of rUKA was £1395 and £1170 relative to TKA and UKA, respectively. The cost per QALY was influenced by case volume: a low-volume centre performing ten cases per year would achieve a cost per QALY of £7170 and £8604 relative to TKA and UKA. For a high-volume centre performing 200 rUKAs per year with a mean two-day length of stay, the cost per QALY would be £648; if performed as day-cases, the cost would be reduced to £364 relative to TKA. For a high-volume centre performing 200 rUKAs per year with a shorter length of stay of one day relative to manual UKA, the cost per QALY would be £574. Conclusion rUKA is a cost-effective alternative to manual TKA and UKA for patients with isolated medial compartment OA of the knee. The cost per QALY of rUKA decreased with reducing length of hospital stay and with increasing case volume, compared with TKA and UKA. Cite this article: Bone Joint J 2019;101-B:1063–1070.

Download Full-text

Utility of transcervical management of Zenker's diverticulum

The Journal of Laryngology & Otology ◽

10.1017/s0022215115003205 ◽

2015 ◽

Vol 130 (S1) ◽

pp. S16-S19 ◽

Cited By ~ 2

Author(s):

B Jackson ◽

Z Ahmad ◽

R P Morton

Keyword(s):

Hospital Stay ◽

Complication Rate ◽

Length Of Hospital Stay ◽

Zenker’S Diverticulum ◽

Cricopharyngeal Myotomy ◽

Pharyngeal Pouch ◽

Recent Systematic Review ◽

Transcervical Approach ◽

Endoscopic Techniques ◽

Zenker's Diverticulum

AbstractObjective:To evaluate our results in treating Zenker's diverticulum via the transcervical approach, and to compare our experiences with a recent systematic review of both open and endoscopic approaches to the pharyngeal pouch.Method:An audit yielded 41 consecutive cases of Zenker's diverticulum treated between 2003 and 2013.Results:All 41 patients underwent transcervical cricopharyngeal myotomy; 29 sacs also required ‘inversion’. The median and mean length of hospital stay was 1 night and 2.5 nights respectively. The recurrence rate was 2.4 per cent and the complication rate was 9.8 per cent.Conclusion:When compared to reported endoscopic techniques, transcervical cricopharyngeal myotomy (with or without inversion) in our unit resulted in: shorter hospital stay, a comparable complication rate and fewer recurrences.

Download Full-text

Impact of surgeon case volume on postoperative complications, mortality, medical costs and length of hospital stay after transurethral resection of the prostate (TURP): A nationwide population-based study in Taiwan

Urological Science ◽

10.1016/j.urols.2016.05.114 ◽

2016 ◽

Vol 27 (2) ◽

pp. S18

Author(s):

Chou Chen-wei ◽

Leonard S. Chuech ◽

Tu Yuan-po ◽

Hsu Fu-shun ◽

Lan Tzuo-Yun

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Transurethral Resection ◽

Length Of Hospital Stay ◽

Medical Costs ◽

Population Based ◽

Case Volume ◽

Population Based Study

Download Full-text

Hospital volumes and the likelihood of stent implantation among patients undergoing catheterization of the left heart: more is more?

European Heart Journal ◽

10.1093/ehjci/ehaa946.3541 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Oettinger ◽

M Zehender ◽

C Von Zur Muehlen ◽

C Bode ◽

K Kaier ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Angiography ◽

Hospital Mortality ◽

Hospital Stay ◽

Stent Implantation ◽

Hospital Volume ◽

Length Of Hospital Stay ◽

High Volume ◽

Artery Disease ◽

Documented Coronary Artery Disease

Abstract Background Percutaneous coronary intervention (PCI) is an established procedure, but recent studies analyzing the indication for stenting are going to change clinical practice. Previous studies suggested that hospital volume is inversely related to in-hospital mortality but its impact on likelihood of stent implantation and the number of stents remains unclear. Purpose There is a conflict of objectives between nationwide care including short transfer and intervention times and a few large centers with maximum technology and experience. We examine the effect of hospital volume on in-hospital mortality, likelihood of stent implantation, number of stents, length of hospital stay, and reimbursement in a recent nationwide cohort from Germany. Methods Using German national electronic health records, all patients who underwent coronary angiography with a documented coronary artery disease were identified by ICD and OPS codes. Risk-adjustment was applied using a predefined set of patient characteristics to account for differences in the risk factor composition of the patient populations between centers. Results In 2017, a total of 528,188 patients with a documented coronary artery disease underwent coronary angiography in Germany. Mean age was 69.8 years and 29.3% of patients were female. 55% of all patients received PCI, with a mean number of 1.01 stents implanted per patient. In-hospital mortality was 2.9%, length of hospital stay was 6.5 days and mean reimbursement was €5,531. Multivariable regression analyses showed a positive linear association between hospital volumes and the likelihood of stent implantation (p=0.003) as well as the number of implanted stents (p=0.020). No association was found between hospital volumes and in-hospital mortality (p=0.105), length of hospital stay (p=0.201) or reimbursement (p=0.108). Inspection of the non-linear impact of procedure volumes on stent implantation practices indicates a ceiling effect in the volume-outcome relationship: implantation likelihood and number of stents per patient are lowest in centers with less than 100 procedures per year (34.4% and 0.62, respectively). Then, implantation likelihood and number of stents constantly increase until the volume category of 500 procedures per year and center. For centers with >500 procedures per year, the likelihood of stent implantation and the number of implanted stents remained relatively constant (about 60% and 1.07, respectively). Conclusion Patients undergoing coronary angiography in low-volume centers are less frequently subject to PCI but at comparable risk for in-hospital mortality. Furthermore, the data suggest that more complex cases are treated in high volume centers with consistent mortality rates and thus constant safety is ensured in high volume hospitals. Thresholds are discussed. Impact of hospital volumes on PCI Funding Acknowledgement Type of funding source: None

Download Full-text

The Relationship between Antimicrobial Resistance and Patient Outcomes: Mortality, Length of Hospital Stay, and Health Care Costs

Clinical Infectious Diseases ◽

10.1086/499406 ◽

2006 ◽

Vol 42 (Supplement_2) ◽

pp. S82-S89 ◽

Cited By ~ 604

Author(s):

Sara E. Cosgrove

Keyword(s):

Health Care ◽

Antimicrobial Resistance ◽

Hospital Stay ◽

Patient Outcomes ◽

Health Care Costs ◽

Length Of Hospital Stay ◽

The Relationship ◽

Care Costs

Download Full-text

Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

F1000Research ◽

10.12688/f1000research.22940.3 ◽

2020 ◽

Vol 9 ◽

pp. 231

Author(s):

Ponco Birowo ◽

William Tendi ◽

Indah S. Widyahening ◽

Nur Rasyid ◽

Widi Atmoko

Keyword(s):

Hospital Stay ◽

Prone Position ◽

Percutaneous Nephrolithotomy ◽

Complication Rate ◽

Length Of Hospital Stay ◽

Operation Time ◽

Major Complication ◽

Stone Free Rate ◽

Major Complication Rate ◽

Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

Download Full-text

Microsurgical Resection of Foramen Magnum Meningioma: Multi-institutional Retrospective Case Series and Proposed Surgical Risk Scoring System.

10.21203/rs.3.rs-253670/v1 ◽

2021 ◽

Author(s):

Nida Fatima ◽

John H. Shin ◽

William T. Curry ◽

Steven D. Chang ◽

Antonio Meola

Keyword(s):

Hospital Stay ◽

Complication Rate ◽

Length Of Hospital Stay ◽

Foramen Magnum ◽

Local Tumor Control ◽

Tumor Control ◽

Local Tumor ◽

Operative Complications ◽

Microsurgical Resection ◽

Post Operative Complications

Abstract Purpose Foramen magnum meningiomas (FMMs) are a major surgical challenge, due to relevant surgical morbidity and mortality. The paper aims to review the clinical (symptomatic improvement, complication rate, length of hospital stay) and radiological outcome (completeness of resection) of microsurgical resection of FMMs, and to identify predictors of complications. Methods A multi-institutional retrospective review of prospectively maintained database of FMMs included 51 patients (74.5% females) with a median tumor volume of 8.18 cm3 (range, 1.77–57.9 cm3) and median follow-up of 36 months (range, 0.30–180.0 months). Tumors were resected though suboccipital approach (58.8%) or transcondylar approach (39.3%). Results Gross-total resection (GTR) was achieved in 80.4%, while local tumor control in 98% of cases. Clinical symptoms improved in 34 patients (66.7%) and worsened in 5 (9.8%). The median length of hospital stay was 5 days. Mortality was null. Postoperative complications developed in 15 patients (29.4%), with cerebrospinal fluid leak (7.8%) and lower cranial nerves deficits (7.8%) as the most frequent. Craniospinal location (p = 0.03), location anterior to the dentate ligament (DL) (p = 0.02), involvement of vertebral artery (VA) (p = 0.03) were significantly associated with complication rate. These three elements allow calculating the Foramen Magnum Meningioma Risk Score (FRMMRS), to estimate the risk of post-operative complications. Conclusion Microsurgical resection allows for high GTR rate and local tumor control rate, despite complications in one third of the patients. The FMMRS allows classifying FMMs and estimating the risk of post-operative complications.

Download Full-text