140 The Effect of Hospital Case-Volume on Pediatric Patients with Resected Posterior Fossa Tumors

Abstract INTRODUCTION Higher volume hospitals correlate with improved markers of quality of care in various surgical specialties. The purpose of this study was to investigate the effect of volume on the outcomes of children undergoing posterior fossa tumor resection. METHODS We queried the Pediatric Health Information System (PHIS) for children ages 0–17 years undergoing posterior fossa tumor resection between 2011 and 2015. Length of hospital stay (LOS), routine discharge home, and adjusted total cost were analyzed for associations with hospital volume (low, medium and high categories, or continuous variable) adjusted for patient demographic and clinical characteristics. LOS was defined as time to routine discharge with patients not routinely discharged censored at time of disposition. RESULTS >A mean of 2893 children per year underwent surgery in 49 U.S. hospitals. The hazard of routine discharge in high volume hospitals was 27% higher than medium (P = 0.0010) and 28% higher than low (P = 0.0003), reflecting shorter LOS in high volume centers. As a binary endpoint, the odds ratios for routine discharge were 1.50 (P = 0.2417), 2.07 (P = 0.0303), and 1.38 (P = 0.2417) for high vs. medium, high vs. low, and medium vs. low volume hospitals, respectively. The geometric mean costs in high volume hospitals were 59% and 37% less than in medium (P = 0.0158) and low volume hospitals (P = 0.1858), respectively. An increase in average annual volume of 50 patients (continuous covariate analysis) increased the hazard of routine discharge by 13% (P = 0.0002), increased the odds of routine discharge by 32% (P = 0.0892), and reduced the geometric mean cost by 27% (P = 0.0767). CONCLUSION Higher volume hospitals in PHIS had improved quality of care (shorter hospital LOS, increased discharge home, and reduced costs) for children requiring posterior fossa tumor resection. Referral to higher volume children's hospitals may improve outcomes for children with newly diagnosed posterior fossa tumors.

Download Full-text

Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03507-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Josephine Obel ◽

Antonio Isidro Carrion Martin ◽

Abdul Wasay Mullahzada ◽

Ronald Kremer ◽

Nanna Maaløe

Keyword(s):

Quality Of Care ◽

Birth Outcomes ◽

Birth Outcome ◽

High Volume ◽

Maternal Health Service ◽

Service Access ◽

Intrapartum Care ◽

Health Service Access ◽

Low Volume

Abstract Background Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes. Methods A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Results Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Conclusions Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

Download Full-text

“Drowning Brain in a Pool of CSF” — A Rare Complication of Periencephalic Subdural Panhygroma following Removal of a Posterior Fossa Tumor

Indian Journal of Neurosurgery ◽

10.1055/s-0037-1602751 ◽

2017 ◽

Vol 07 (03) ◽

pp. 223-226

Author(s):

Bikash Behera ◽

Ram Deo ◽

Sanjib Mishra ◽

Jyotirmayee Biswal ◽

Deepak Das

Keyword(s):

Posterior Fossa ◽

Case Reports ◽

Rare Complication ◽

Tumor Resection ◽

Foramen Magnum ◽

Posterior Fossa Tumor ◽

Subdural Hygroma ◽

Posterior Fossa Tumors ◽

Suboccipital Craniotomy ◽

Pediatric Age Group

AbstractPosterior fossa tumors are commonly encountered in pediatric age group patients. Most of these tumors present with features of hydrocephalus in the child. Conventionally, these cases are managed by suboccipital craniotomy with decompression of the tumor mass to establish the free flow of cerebrospinal fluid (CSF) across fourth ventricle and aqueduct of Sylvius. Following resection of posterior fossa tumor, appearance of subdural hygroma is a rare phenomenon.Though few cases of subdural hygroma are reported in literature following foramen magnum decompression in Chiari's malformation, their appearance following posterior fossa tumor resection is alien to medical literature and limited to only two case reports. Here the authors present a patient with periencephalic subdural panhygroma (PSP) following posterior fossa tumor resection who was successfully treated with a ventriculoperitoneal shunt (VPS) to accomplish a symptomatic and radiologic remission.

Download Full-text

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

Journal of Neurosurgery ◽

10.3171/jns.1995.83.3.0467 ◽

1995 ◽

Vol 83 (3) ◽

pp. 467-475 ◽

Cited By ~ 101

Author(s):

Andrew T. Dailey ◽

Guy M. McKhann ◽

Mitchel S. Berger

Keyword(s):

Posterior Fossa ◽

Pediatric Patients ◽

Tumor Resection ◽

Posterior Fossa Tumor ◽

Posterior Fossa Tumors ◽

Lower Cranial Nerve ◽

Content Type ◽

Cranial Nerve Function ◽

Pharyngeal Musculature ◽

Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Download Full-text

Prone Positioning for Posterior Fossa Tumor Resection

10.1093/med/9780199764495.003.0037 ◽

2013 ◽

Author(s):

Matthias W König ◽

Mohamed A Mahmoud ◽

John J McAuliffe

Keyword(s):

Brain Tumors ◽

Prone Position ◽

Posterior Fossa ◽

Tumor Resection ◽

Posterior Fossa Tumor ◽

Physiological Changes ◽

Prone Positioning ◽

Posterior Fossa Tumors ◽

Common Malignancy

Brain tumors are the second most common malignancy in children. About one third occur in toddlers under the age of 3, and about two thirds are located in the posterior fossa. Resection of posterior fossa tumors is often a lengthy procedure that is commonly performed in the prone position. The prone position is associated with physiological changes and predisposes the patient to certain types of injuries.

Download Full-text

Histologic Subtypes of Ovarian Carcinoma: Selected Diagnostic and Classification Problems in Bulgaria: Is Low Hospital Volume an Issue?

Tumori Journal ◽

10.5301/tj.5000571 ◽

2016 ◽

Vol 103 (2) ◽

pp. 148-154 ◽

Cited By ~ 2

Author(s):

Vesela Ivanova ◽

Tihomir Dikov ◽

Nadya Dimitrova

Keyword(s):

Ovarian Cancer ◽

Quality Of Care ◽

Ovarian Carcinoma ◽

Cancer Patients ◽

Hospital Volume ◽

Clear Cell ◽

High Volume ◽

Ovarian Carcinomas ◽

Low Volume

Purpose To provide an overview of the morphologic subtypes of ovarian carcinomas in Bulgaria in relation to current healthcare organization using Bulgarian National Cancer Registry data. Further, we investigated hospital volume as a factor influencing the quality of care for patients with ovarian cancer. Methods Bulgarian National Cancer Registry ovarian carcinoma data were retrieved (2009-2011) and distribution of histologic types was analyzed. Cases were divided and compared with respect to main treatment: no surgery, surgery at hospitals dealing with ≥30 ovarian cancer patients/year (high volume), and surgery at hospitals dealing with <30 ovarian cancer patients/year (low volume). We then estimated the odds of being diagnosed with adenocarcinoma and carcinoma not otherwise specified (NOS) vs specified morphologies (serous, endometrioid, clear cell, and mucinous), including age, grade, stage, and hospital volume, in a logistic regression model. Results A total of 2,041 ovarian carcinomas were distributed as follows: serous 47.7%, mucinous 11.9%, endometrioid 5.8%, clear cell 1.8%, and adenocarcinoma and carcinoma NOS 32.5%. More than half of cancer patients (n = 1,100, 53.9%) were surgically treated in low-volume hospitals and they had a larger proportion of cases with adenocarcinoma and carcinoma NOS: 33.3%, in comparison with 24.0% in high-volume hospitals (p<0.0001). The odds of being diagnosed with unspecified morphology, assumed as a proxy of suboptimal quality of care, are higher for patients surgically treated in low-volume hospitals (odds ratio 1.50 [95% confidence interval 1.21-1.87]) compared with high-volume hospitals after adjustment for age, stage, and grade. Conclusions The results of our study may serve policymakers and healthcare professionals when optimizing diagnosis and treatment of ovarian cancer in Bulgaria.

Download Full-text

Cranial magnetic resonance imaging findings of leptomeningeal contrast enhancement after pediatric posterior fossa tumor resection and its significance

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.4.peds1058 ◽

2010 ◽

Vol 6 (1) ◽

pp. 87-91 ◽

Cited By ~ 4

Author(s):

Jonathan Loree ◽

Vivek Mehta ◽

Ravi Bhargava

Keyword(s):

Mr Imaging ◽

Posterior Fossa ◽

Imaging Techniques ◽

Tumor Resection ◽

Imaging Study ◽

Leptomeningeal Metastases ◽

Posterior Fossa Tumor ◽

Imaging Findings ◽

Mr Images ◽

Posterior Fossa Tumors

In this report, the authors illustrate the potential shortfalls of early postoperative MR imaging following resection of a posterior fossa tumor. The authors present the cases of a 10-month-old boy and a 14-year-old boy with posterior fossa tumors that were surgically resected and monitored immediately postoperatively with MR imaging. The MR imaging study obtained immediately postresection while the children were still anesthetized revealed enhancing elements in both patients, which were suggestive of leptomeningeal metastases. When this signal was followed on subsequent MR images, it was no longer visible. The patients are both recurrence free at the time of this publication. These cases demonstrate that early postoperative MR imaging findings for leptomeningeal metastases may be unreliable after excision of posterior fossa tumors and may have potential implications for intraoperative MR imaging techniques currently under development.

Download Full-text