SURG-26. READMISSION FOLLOWING RESECTION FOR PATIENTS WITH BRAIN METASTASES IN THE UNITED STATES

Abstract OBJECTIVE Up to 30% of cancer patients will develop brain metastasis during the course of their systemic disease with a significant proportion undergoing resection of at least one lesion. The objective of the present study was to characterize the rates, predictors, and costs of 30-day readmissions following craniotomy for brain metastases using a nationally representative database. METHODS This study was a retrospective analysis of data from the Nationwide Readmissions Database (NRD) from 2010–2014. We included patients who underwent craniotomy for brain metastasis, identified using ICD-9-CM diagnosis (198.3) and procedure (01.59) codes. The primary outcome of the study was unplanned 30-day all-cause readmission rates. Secondary outcomes included predictors and costs of readmissions. RESULTS During the study period, there were 44,846 index hospitalizations for patients who underwent resection of brain metastasis. Among this cohort, 17.8% (n=7,965) had unplanned readmissions within the first 30 days after discharge from the index hospitalization. The readmission rate did not change significantly during the study period (P=0.286). The odds of unplanned readmission were significantly greater in patients with thromboembolic complications (aOR, 1.53; 95% CI: 1.18–2.01), patients with Elixhauser comorbidities >3 (aOR, 1.35; 95% CI: 1.22–1.50), male patients (adjusted odds ratio [aOR], 1.29; 95% CI: 1.17–1.42), patients with an initial length of stay ≥5 days (aOR, 1.02; 95% CI: 1.01–1.03). The median per-patient cost for 30-day unplanned readmission was $11,109 and this accounted for a total cost of $132.1 million during the study period. CONCLUSIONS Unplanned readmissions after resection for brain metastases involve substantial healthcare expenditures. Though there have been many interventions for improving surgical quality, post-operative care, and cost metrics, unplanned readmission rates have not changed. Key patient-specific variables and high rates of comorbidities should be considered to focus our efforts on patient selection for resection, and for strengthening existing interventions for high-risk patients.

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Age Based Trends for Unplanned Pediatric Rehospitalizations in the United States

10.1101/2021.11.13.21266306 ◽

2021 ◽

Author(s):

Nupur Amritphale ◽

Amod Amritphale ◽

Deepa Vasireddy ◽

Mansi Batra ◽

Mukul Sehgal ◽

...

Keyword(s):

Hospital Readmission ◽

Readmission Rate ◽

Age Groups ◽

The United States ◽

Unplanned Readmission ◽

Post Discharge ◽

Readmission Rates ◽

Discharge Care ◽

Hospital Readmission Rate ◽

Bowel Diseases

BACKGROUND AND OBJECTIVES: Hospital readmission rate helps to highlight the effectiveness of post- discharge care. There remains a paucity of plausible age based categorization especially for ages below one year for hospital readmission rates. METHODS: Data from 2017 Healthcare cost and utilization project National readmissions database was analyzed for ages 0-18 years. Logistic regression analysis was performed to identify predictors for unplanned early readmissions. RESULTS: We identified 5,529,389 inpatient pediatric encounters which were further divided into age group cohorts. The overall rate of readmissions was identified at 3.2%. Beyond infancy, the readmission rate was found to be 6.7%. Across all age groups, the major predictors of unplanned readmission were cancers, diseases affecting transplant recipients and sickle cell patients. It was determined that reflux, milk protein allergy, hepatitis and inflammatory bowel diseases were significant comorbidities leading to readmission. Anxiety, depression and suicidal ideation depicted higher readmission rates in those older than 13 years. Across ages 1-4 yrs, dehydration, asthma and bronchitis were negative predictors of unplanned readmission. CONCLUSIONS: Thirty-day unplanned readmissions remain a problem leading to billions of tax-payer-dollars lost per annum. Effective strategies for mandatory outpatient follow-up may help the financial aspect of care while also enhancing the quality of care.

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Trends in utilization, perioperative outcomes, and costs among open, laparoscopic, and robotic nephroureterectomies: A 10-year population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.337 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 337-337

Author(s):

Francisco Jose Gelpi-Hammerschdmidt ◽

Christopher B. Allard ◽

Benjamin I. Chung ◽

Steven L. Chang

Keyword(s):

United States ◽

Hospital Costs ◽

The United States ◽

Population Based ◽

Perioperative Outcomes ◽

Patient Specific ◽

Complication Rates ◽

Incidence Risk ◽

Nationally Representative ◽

Survey Weighting

337 Background: Nephroureterectomy (NU) is the standard treatment for upper tract urothelial carcinoma (UTUC). Minimally invasive (MI) laparoscopic or robotic-assisted approaches have been introduced in an effort to reduce morbidity. We performed a population-based study to evaluate contemporary utilization trends, morbidity, and costs associated with NUs in the United States. Methods: Using the Premier Hospital Database (Premier, Inc., Charlotte, NC), a nationally representative discharge database with data from over 600 non-federal hospitals in the United States, we captured patients who underwent a NU (ICD-9 55.51) with diagnoses of renal pelvis (189.1) or ureteral (189.2) neoplasms from 2004 to 2013. We fitted regression models, adjusting for clustering by hospitals and survey weighting to evaluate 90-day postoperative complications, length of stay (LOS), OR time, and direct hospital costs among open, laparoscopic, and robotic NU. Results: The weighted cohort included 17,245 open, 13,298 laparoscopic, and 3,745 robotic NUs. MI surgeries increased from 36% to 54% from 2004 to 2013, while the number of NUs decreased by nearly 20% during the same period (Figure 1). The overall 90-day mortality, major (Clavien 3-5), and minor (Clavien 1-2) complication rates were 1.89%, 9.4%, and 27.7%, respectively, with no statistically significant differences between the three approaches based on adjusted logistic regression analyses. The LOS was decreased for laparoscopic (Incidence Risk Ratio [IRR]: 0.87, 95% CI: 0.82-0.92, p<0.001) and robotic (IRR: 0.76, 95% CI: 0.7-0.83, p<0.001) NU compared to open NU. OR time was 10.35 (p<0.05) and 56.35 (p<0.001) minutes longer for laparoscopic and robotic NU. Adjusted 90-day median direct hospital costs were $1,354 and $3,533 higher for laparoscopic and robotic NU (p<0.001). Conclusions: During this contemporary 10-year study, the use of MI NUs increased to over half of procedures with a recent surge in robotic NUs, along with a concurrent reduction in total NUs performed in the United States. Comparable perioperative outcomes suggest that the morbidity profile may be driven primarily by patient-specific characteristics as opposed to surgical approach.

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Outcomes in patients with brain metastasis from esophageal carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.159 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 159-159

Author(s):

Nadia Saeed ◽

Nishi Kothari ◽

Eric Albert Mellon ◽

Sarah E. Hoffe ◽

Jessica M. Frakes ◽

...

Keyword(s):

Esophageal Cancer ◽

Brain Metastasis ◽

Brain Metastases ◽

Esophageal Carcinoma ◽

Median Survival ◽

Systemic Disease ◽

Class I ◽

Definitive Treatment ◽

Class Iii ◽

Definitive Therapy

159 Background: Brain metastases from esophageal carcinoma have historically been rare. With improvements in systemic therapy, patients are living longer and the incidence of brain metastasis (mets) is expected to rise. However, there is no consensus on management. We present our single institution experience with brain mets from esophageal cancer. Methods: We retrospectively identified 49 patients (pts) with brain mets from primary esophageal cancer who were treated at our tertiary referral center between 1998 and 2015. Medical records were reviewed to collect demographic and clinical information. Results: Median age at diagnosis of the primary esophageal cancer was 60 years. 41 pts were male. 39 pts had adenocarcinoma, 4 had squamous cell carcinoma, 4 had poorly differentiated carcinoma, and 1 had neuroendocrine carcinoma. Stage at diagnosis ranged from I-IV. 7pts had synchronous brain mets, defined as occurring within 3 months of diagnosis. The remaining pts were found to have brain mets more than 3 months after diagnosis. 27 pts had a solitary met, 12 had two lesions, and the rest had multiple lesions. For primary treatment, 12 pts had surgery only, 8 had stereotactic radiosurgery (SRS) as a definitive treatment, and the remainder had a combination of surgery, SRS, and whole brain radiation therapy. Median survival following esophageal cancer diagnosis was 24 months (range 3-71), and median survival after the identification of brain mets was 5 months (range 1-52). Using the recursive partitioning score (RPA), 15 pts had class I disease and 28 had class II, and 6 had class III disease. Those with class I or II disease had significantly improved overall survival (p < 0.001). Conclusions: Brain metastases from esophageal cancer are rare with overall poor prognosis. However, some pts can have prolonged survival. In the largest series to date, we found that pts with controlled systemic disease and limited number of brain lesions who had definitive therapy (surgery or SRS) had better outcome. Aggressive treatment may improve outcomes.

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Brain Metastasis in Bone and Soft Tissue Cancers: A Review of Incidence, Interventions, and Outcomes

Sarcoma ◽

10.1155/2014/475175 ◽

2014 ◽

Vol 2014 ◽

pp. 1-19 ◽

Cited By ~ 31

Author(s):

Faris Shweikeh ◽

Laura Bukavina ◽

Kashif Saeed ◽

Reem Sarkis ◽

Aarushi Suneja ◽

...

Keyword(s):

Soft Tissue ◽

Brain Metastasis ◽

Brain Metastases ◽

Peripheral Nerve ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Systemic Disease ◽

Nerve Sheath Tumors ◽

Peripheral Nerve Sheath Tumors ◽

Nerve Sheath

Bone and soft tissue malignancies account for a small portion of brain metastases. In this review, we characterize their incidence, treatments, and prognosis. Most of the data in the literature is based on case reports and small case series. Less than 5% of brain metastases are from bone and soft tissue sarcomas, occurring most commonly in Ewing’s sarcoma, malignant fibrous tumors, and osteosarcoma. Mean interval from initial cancer diagnosis to brain metastasis is in the range of 20–30 months, with most being detected before 24 months (osteosarcoma, Ewing sarcoma, chordoma, angiosarcoma, and rhabdomyosarcoma), some at 24–36 months (malignant fibrous tumors, malignant peripheral nerve sheath tumors, and alveolar soft part sarcoma), and a few after 36 months (chondrosarcoma and liposarcoma). Overall mean survival ranges between 7 and 16 months, with the majority surviving < 12 months (Ewing’s sarcoma, liposarcoma, malignant fibrous tumors, malignant peripheral nerve sheath tumors, angiosarcoma and chordomas). Management is heterogeneous involving surgery, radiosurgery, radiotherapy, and chemotherapy. While a survival advantage may exist for those given aggressive treatment involving surgical resection, such patients tended to have a favorable preoperative performance status and minimal systemic disease.

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The Role of Postoperative Radiotherapy after Resection of Single Brain Metastases

Neurosurgery ◽

10.1227/00006123-198906000-00002 ◽

1989 ◽

Vol 24 (6) ◽

pp. 798-805 ◽

Cited By ~ 167

Author(s):

Lisa M. DeAngelis ◽

Lynda R. Mandell ◽

H. Tzvi Thaler ◽

David W. Kimmel ◽

Joseph H. Galicich ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Postoperative Radiotherapy ◽

Systemic Disease ◽

Whole Brain Radiotherapy ◽

Complete Resection ◽

Term Survival ◽

Single Brain Metastasis ◽

Group A ◽

Group B

ABSTRACT To assess the value of whole brain radiotherapy (WBRT) after complete resection of a single brain metastasis we reviewed the records of 98 patients who had elective craniotomy between 1978 and 1985. Seventy-nine patients received postoperative WBRT (Group A) and 19 patients no radiotherapy (RT) (Group B). Neurological relapse was designated as local (i.e., at the site of the original metastasis) or distant (i.e., elsewhere in the brain). Postoperative WBRT significantly prolonged the time to any neurological relapse (P = 0.034) with a 1-year recurrence rate of 22% in Group A and 46% in Group B patients; however, it did not specifically control either local or distant cerebral recurrence. Recurrence of metastatic brain disease was not affected by location of the original lesion; however, meningeal relapse occurred in 38% of cerebellar lesions, but only in 4.7% of supratentorial metastases (P = 0.003). The total radiation dose or fractionation scheme of RT did not affect survival nor time to neurological relapse. The median survival was 20.6 and 14.4 months for Groups A and B, respectively (not statistically different). Forty-eight percent of Group A and 47% of Group B patients survived for 1 year or longer; however, 11% of patients who had received RT and survived 1 year developed severe radiation-induced dementia. All patients with radiation-related cerebral damage received hypo-fractionated RT with high daily fractions as commonly designed for rapid palliation of macroscopic brain metastases. Thus, postoperative WBRT may be an important adjunct to complete resection of a single brain metastasis, particularly in patients with limited or no systemic disease who have the potential for long-term survival or even cure, but it carries a substantial risk of late neurological toxicity when hypofractionated RT schedules are used. For these good-risk patients, postoperative WBRT should be administered by standard fractionation schemes of 180 to 200 cGy/day to a total of 4000 to 4500 cGy, or hyperfractionation, which provides even lower doses/fraction to minimize potential neurotoxicity while delivering a maximally efficacious total dose, should be considered.

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Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

10.21203/rs.3.rs-73159/v1 ◽

2020 ◽

Author(s):

Zhen Lin ◽

Yinghong Zhai ◽

Hedong Han ◽

Yang Cao ◽

Cheng Wu ◽

...

Keyword(s):

The United States ◽

Medical Advice ◽

Unplanned Readmission ◽

Post Discharge ◽

Readmission Rates ◽

Against Medical Advice ◽

Medical Institutions ◽

Vulnerable Patients ◽

Significant Difference ◽

Hospitalization Costs

Abstract Background: To describe characteristics of sepsis patients who discharged against medical advice (AMA), identify factors associated with AMA discharges in the patients, and evaluate the association of AMA discharge with 30-day unplanned readmission and outcomes of readmission.Methods: Using the National Readmission Database of the United States, we identified inpatients with sepsis who discharged AMA or discharged home between 2010 and 2017. The baseline characteristics were compared between the two groups. Multivariable models were used to identify factors related to AMA discharge, evaluate the association between AMA discharge and 30-day unplanned readmission, and elucidate the relationship between the AMA discharges and in-hospital outcomes.Results: AMA discharges accounted for 2.29% of all the hospitalized sepsis patients. The prevalence of AMA discharge in sepsis patients increased from 1.99% in 2010 to 2.55% in 2014 (p for trend < 0.001).The unplanned 30-day readmission rates of sepsis patients who discharged AMA and who discharged home are 25.51% and 12.26%, respectively. AMA discharge is statistically significantly associated with 30-day [odds ratio (OR), 2.24; 95% confidence interval (CI), 2.15–2.33], 60-day (OR, 2.07; 95% CI, 1.99–2.15), and 90-day (OR, 1.97; 95% CI, 1.90–2.05) readmission. AMA discharge is also associated with longer length of stay in 30 days (0.44 day, 95% CI, 0.12 days-0.76 days, p=0.007), whereas there was no statistically significant difference in hospitalization costs and in-hospital mortality for patients discharged AMA versus those discharged home.Conclusions: Due to the high risk of readmission, vulnerable patients should be early identified. Medical institutions should conduct post-discharge interventions for patients with AMA discharge, such as follow-up visits and psychological counseling, to reduce readmission.

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Factors associated with unplanned readmissions and costs following resection of brain metastases in the United States

Scientific Reports ◽

10.1038/s41598-021-01641-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Raees Tonse ◽

Alexandra Townsend ◽

Muni Rubens ◽

Vitaly Siomin ◽

Michael W. McDermott ◽

...

Keyword(s):

High Risk ◽

Brain Metastasis ◽

Readmission Rate ◽

The United States ◽

Neurological Complications ◽

Infectious Complications ◽

Unplanned Readmission ◽

Factors Associated ◽

High Risk Patients ◽

Risk Patients

AbstractThe purpose of this study was to critically analyze the risk of unplanned readmission following resection of brain metastasis and to identify key risk factors to allow for early intervention strategies in high-risk patients. We analyzed data from the Nationwide Readmissions Database (NRD) from 2010–2014, and included patients who underwent craniotomy for brain metastasis, identified using ICD-9-CM diagnosis (198.3) and procedure (01.59) codes. The primary outcome of the study was unplanned 30-day all-cause readmission rate. Secondary outcomes included reasons and costs of readmissions. Hierarchical logistic regression model was used to identify the factors associated with 30-day readmission following craniotomy for brain metastasis. During the study period, 44,846 index hospitalizations occurred for patients who underwent resection of brain metastasis. In this cohort, 17.8% (n = 7,965) had unplanned readmissions within the first 30 days after discharge from the index hospitalization. The readmission rate did not change significantly during the five-year study period (p-trend = 0.286). The median per-patient cost for 30-day unplanned readmission was $11,109 and this amounted to a total of $26.4 million per year, which extrapolates to a national expenditure of $269.6 million. Increasing age, male sex, insurance status, Elixhauser comorbidity index, length of stay, teaching status of the hospital, neurological complications and infectious complications were associated with 30-day readmission following discharge after an index admission for craniotomy for brain metastasis. Unplanned readmission rates after resection of brain metastasis remain high and involve substantial healthcare expenditures. Developing tools and interventions to prevent avoidable readmissions could focus on the high-risk patients as a future strategy to decrease substantial healthcare expense.

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Real-world hypothesis-generating cohort of pancreatic cancer patients with brain metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16720 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16720-e16720

Author(s):

Derek Cridebring ◽

David Hadley ◽

Timothy S Scott ◽

Alex B Vilner ◽

Tammy M Heckman ◽

...

Keyword(s):

Pancreatic Cancer ◽

Brain Metastasis ◽

Brain Metastases ◽

Lung Metastases ◽

The United States ◽

The Body ◽

Secondary Malignancy ◽

Information Management Systems ◽

Age Of Diagnosis ◽

The Brain

e16720 Background: Pancreatic cancer (PC) is the third most lethal form of cancer in the United States, and is most often diagnosed having already metastasized, making its 5-year survival rate one of the lowest. Metastatic PC (mPC) is most common at sites such as liver, lymph nodes, and lung while, in contrast, brain metastases from PC are rare. Brain metastases present a major challenge for future oncological research, as they are difficult to treat. If PC patients most likely to develop brain metastases can be identified earlier, there is an opportunity for rapid therapeutic intervention. There is limited research and understanding of the relationship between pancreatic cancer and brain metastases. Methods: We performed a retrospective, non-interventional study using deidentified data. Inteliquet’s data was aggregated from its consortium of 175 US healthcare locations, which includes a variety of source systems at each site. These sources include electronic medical record systems, laboratory information management systems, and other sources. A subset of the adult mPC data originally treated at HonorHealth was identified as an exploratory cohort. Results: 833 patient records were identified with drug treated mPC, 33 (4%) of which had metastasized to the brain. The PC dataset had a median diagnosis age of 65 and was 46% female. The site of the primary tumor within the pancreas was acquired from ICD10 code: 35% were in the head, 14% in the tail, 15% in the body, 5% in overlapping sites, 6% in other parts and 26% where location was unspecified. Metastatic locations came from secondary malignancy ICD10 codes: 63% had liver and 25% had lung metastases, which aligns with prior studies. For patients with brain metastases, the gender distribution was 42% female, while the distribution of primary PC site was: 33% head, 9% tail, 6% body, 6% in overlapping locations, 12% in other parts and 33% with unspecified location. The median age of diagnosis in the brain metastasis group was 67 years. Conclusions: This is the largest study of PC patients with brain metastases that we could find. 33 patients out of 833 had brain metastases compared to a recent review which had 25 cases. Our data suggests that specification of the primary pancreatic site is more difficult, aside from the head of the pancreas. Analyses are underway to explore correlations between other clinical factors and brain metastases, and to calculate the time in between the initial pancreatic cancer diagnosis and detection of the brain metastasis. This hypothesis-generating cohort will be tested in patient data from the rest of the consortium.

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The results of resection after stereotactic radiosurgery for brain metastases

Journal of Neurosurgery ◽

10.3171/2009.4.jns09246 ◽

2009 ◽

Vol 111 (4) ◽

pp. 825-831 ◽

Cited By ~ 20

Author(s):

Hideyuki Kano ◽

Douglas Kondziolka ◽

Oscar Zorro ◽

Javier Lobato-Polo ◽

John C. Flickinger ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Surgical Navigation ◽

Systemic Disease ◽

Univariate Analysis ◽

Tumor Control ◽

Karnofsky Performance Scale ◽

Surgical Removal ◽

Local Progression

Object Radiosurgery for brain metastasis fails in some patients, who require further surgical care. In this paper the authors' goal was to evaluate prognostic factors that correlate with the survival of patients who require a resection of a brain metastasis after stereotactic radiosurgery (SRS). Methods During the last 14 years when surgical navigation systems were routinely available, the authors identified 58 patients who required resection for various brain metastases after SRS. The median patient age was 54 years. Prior adjuvant treatment included whole-brain radiation therapy alone (17 patients), chemotherapy alone (9 patients), both radiotherapy and chemotherapy (10 patients), and prior resection before SRS (8 patients). The median target volumes at the time of SRS and resection were 7.7 cm3 (range 0.5–24.9 cm3) and 15.5 cm3 (range 1.3–81.2 cm3), respectively. Results At a median follow-up of 7.6 months, 8 patients (14%) were living and 50 patients (86%) had died. The survival after surgical removal was 65, 30, and 16% at 6, 12, and 24 months, respectively (median survival after resection 7.7 months). The local tumor control rate after resection was 71, 62, and 43% at 6, 12, and 24 months, respectively. A univariate analysis revealed that patient preoperative recursive partitioning analysis classification, Karnofsky Performance Scale status, systemic disease status, and the interval between SRS and resection were factors associated with patient survival. The mortality and morbidity rates of resection were 1.7 and 6.9%, respectively. Conclusions In patients with symptomatic mass effect after radiosurgery, resection may be warranted. Patients who had delayed local progression after SRS (> 3 months) had the best outcomes after resection.

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Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

Journal of Neurosurgery ◽

10.3171/jns.1995.83.4.0605 ◽

1995 ◽

Vol 83 (4) ◽

pp. 605-616 ◽

Cited By ~ 143

Author(s):

Marek Wroński ◽

Ehud Arbit ◽

Michael Burt ◽

Joseph H. Galicich

Keyword(s):

Lung Cancer ◽

Brain Metastasis ◽

Brain Metastases ◽

Lung Tumor ◽

Systemic Disease ◽

Postoperative Mortality ◽

Nonsmall Cell Lung Cancer ◽

Karnofsky Performance Scale ◽

Incomplete Resection ◽

Term Survival

✓ The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; postoperative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.

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