The Impact of Hospital Safety-Net Burden on Outcomes for Primary Supratentorial Brain Tumor Surgery

Abstract INTRODUCTION Safety-net hospitals treat a disproportionate share of vulnerable patient populations. While outcomes at these institutions for neurosurgical procedures, such as cerebral aneurysm surgery, have been researched, the impact of safety-net burden on brain tumor surgery is poorly characterized. METHODS Using International Classification of Diseases-9 diagnosis codes, we identified all adult admissions in the National Inpatient Sample from 2002 to 2011 undergoing craniotomy for a primary supratentorial brain tumor (191.0-5, 191.8-9, 225.0 and 237.5), excluding patients with brain metastasis (198.3). For each hospital, we quantified safety-net burden as the percentage of patients on Medicaid or without insurance. Hospitals in the top quartile of safety-net burden were categorized as high-burden hospitals (HBHs) while the remainder were low-burden hospitals (LBHs). Survey-weighted multivariate regression was used to make national estimates and adjust for 12 confounding variables: age, sex, insurance, household income, severity of illness and risk of mortality scores, Charlson Comorbidity Index, malignant status, hospital ownership, teaching status, region, and volume. RESULTS We analyzed 162 828 total admissions admitted to 1135 hospitals for brain tumor craniotomy in 2002 to 2011. A total of 212 hospitals (19%) were classified as HBHs, treating 16 914 admissions. HBHs were more likely to be low-volume and public hospitals (both P < .001). Moreover, patients at HBHs were less likely to be white and had higher severity of illness scores (both P < .001). When evaluating outcomes, hospital safety-net status was not associated with mortality (P = .260), favorable discharge disposition (P = .765), or perioperative complications (P = .757). However, admission to HBHs was associated with higher length of stay (+ 0.74 d, P = .007) and inpatient costs (+ $2 448, P = .002). CONCLUSION Although safety-net burden was not associated with mortality, disposition, or complications, patients at safety-net hospitals exhibited increased length of stay and costs, potentially due to factors like resource limitations or more advanced disease presentation among safety-net patients. Amidst potential reforms like “pay-for-performance” reimbursement models, it is critical to further study neurosurgical outcomes at safety-net hospitals.

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Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

10.21203/rs.3.rs-227538/v2 ◽

2021 ◽

Author(s):

Da-wei Zhao ◽

Xu-yang Zhang ◽

Kai-yan Wei ◽

Yi-bin Jiang ◽

Dan Liu ◽

...

Keyword(s):

Risk Factors ◽

Brain Tumor ◽

Brain Tumors ◽

Operation Time ◽

Postoperative Pneumonia ◽

Tumor Surgery ◽

Regression Analyses ◽

Brain Tumor Surgery ◽

The Impact ◽

Preoperative Albumin

Abstract Hypoalbuminemia is associatied with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pneumonia had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pneumonia were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and is associated with postoperative pneumonia in patients undergoing brain tumor surgery.

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Length of stay in neurocritical care after brain tumor surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-201406001-00558 ◽

2014 ◽

Vol 31 ◽

pp. 196 ◽

Cited By ~ 1

Author(s):

J. Benatar-Haserfaty ◽

D. Ly-Liu ◽

Gonzalez V. Moreno ◽

Tiscar C. García

Keyword(s):

Brain Tumor ◽

Length Of Stay ◽

Neurocritical Care ◽

Tumor Surgery ◽

Brain Tumor Surgery

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Commentary: Predicting Inpatient Length of Stay After Brain Tumor Surgery: Developing Machine Learning Ensembles to Improve Predictive Performance

Neurosurgery ◽

10.1093/neuros/nyy453 ◽

2018 ◽

Vol 85 (3) ◽

pp. E444-E445

Author(s):

Brooks V Udelsman ◽

Pamela S Jones ◽

Yanik J Bababekov ◽

Bob S Carter ◽

David C Chang

Keyword(s):

Machine Learning ◽

Brain Tumor ◽

Length Of Stay ◽

Predictive Performance ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Learning Ensembles ◽

Inpatient Length Of Stay

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114 Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital

Neurosurgery ◽

10.1093/neuros/nyx417.114 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 224-224

Author(s):

Anthony Michael DiGiorgio ◽

Praveen V Mummaneni ◽

Jonathan Lloyd Fisher ◽

Adam Podet ◽

Clifford Crutcher ◽

...

Keyword(s):

Length Of Stay ◽

Tertiary Care ◽

Wait Time ◽

Multivariate Regression Analysis ◽

Safety Net ◽

Neurosurgical Procedures ◽

Urgent Surgery ◽

Period 2 ◽

Safety Net Hospital ◽

The Impact

Abstract INTRODUCTION The practice of surgeons performing overlapping surgery has recently come under scrutiny. We sought to examine the impact of overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS Our hospital functions as a safety-net, tertiary care, level-1 trauma center in the Southern United States. The neurosurgery service transitioned from routinely allowing one room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked. RESULTS >452 total cases were reviewed (201 in period 1 & 251 in period 2), covering 7 months in each period. 122 of the cases were classified as “urgent” (59 in period 1 and 63 in period 2). In the these patients, length of stay was significantly decreased in period 2 (13.09 days vs 19.52, p = .002) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 days vs 7.00, p = .084). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial and the remainder workers compensation, liability or prisoner care. Multivariate regression analysis revealed that being in period 1, having Medicare, having trauma as the indication for surgery, and undergoing a non-cranial or non-spinal procedure as significant factors for increased length of stay. CONCLUSION Recent studies suggest overlapping surgeries are safe for patients. In the case of our safety net hospital, allowing the neurosurgery service to run overlapping rooms significantly reduces length of stay in a vulnerable population who is admitted in need of urgent surgery.

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Effect of hemostasis and electrosurgery on the development and evolution of brain tumor surgery in the late 19th and early 20th centuries

Neurosurgical FOCUS ◽

10.3171/foc.2005.18.4.4 ◽

2005 ◽

Vol 18 (4) ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

John R. Vender ◽

Jason Miller ◽

Andy Rekito ◽

Dennis E. McDonnell

Keyword(s):

Brain Tumor ◽

Brain Tissue ◽

Surgical Management ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

The Impact ◽

Neurological Surgeon ◽

The Brain ◽

Development And Evolution ◽

Type Of Surgery

Hemostatic options available to the surgeon in the late 19th and early 20th centuries were limited. The surgical ligature was limited in value to the neurological surgeon because of the unique structural composition of brain tissue as well as the approaches and operating angles used in this type of surgery. In this manuscript the authors review the options available and the evolution of surgical hemostatic techniques and electrosurgery in the late 19th and early 20th centuries and the impact of these methods on the surgical management of tumors of the brain and its coverings.

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389 Advanced Intraoperative Navigated Ultrasound in Brain Tumor Surgery Lessons Learnt from a Personal Experience of 300 Cases

Neurosurgery ◽

10.1093/neuros/nyx417.389 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 293-293

Author(s):

Aliasgar V Moiyadi

Keyword(s):

Brain Tumor ◽

Malignant Gliomas ◽

Tumor Resection ◽

3D Ultrasound ◽

Small Subset ◽

Neurosurgical Procedures ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Resection Control ◽

Tumor Residue

Abstract INTRODUCTION Navigated 3D-ultrasound (nUS) is a powerful and multi-purpose adjunct during tumor resections. We review our cumulative results in a dedicated neuro-oncology service spanning a six year period, highlighting its role in glioma surgery. METHODS Since 2011 we have been used a navigated 3D ultrasound system for intraoperative image guidance during brain tumor surgery in 300 cases. A prospectively updated database was queried to retrieve demographic, clinico-radiological and pathological details. Specifically, we evaluated the utility of the IOUS in different setups and assessed its predictive accuracy and impact on extent of resection (EOR) as well as survival in gliomas. RESULTS >300 (204 males/96 females) brain tumors were operated [197 high grade gliomas, 28 LGG, 24 Meningiomas, and 51 other tumors]. Radical resection/debulking was intended in 270 (90%). In 30 (10%), only frameless biopsy was performed. The US was intended for resection control in 219 (73%) tumors, most of them being intrinsic gliomas. Intermediate scans prompted further resection in 101 cases (46%). A final resection control scan was performed in 176 cases (confirming complete excision in 99, and residual tumor which could not be further resected in 77). The nUS was a very useful tool in tumor surgery, providing a good diagnostic accuracy (85-90%) in predicting tumor residue. It also helped us improve the EOR in malignant gliomas as well as non-enhancing gliomas. In the subset of resectable tumors, the gross total resection rate was 88%. Further, in a small subset of malignant gliomas, we demonstrated that it helps extend tumor resection beyond the contrast enhancement zone. In GBMs, in a multivariate model, use of the nUS was an independent predictor of survival. CONCLUSION Considering the ease of use, widespread accessibility and low-cost nature, IOUS can be a potentially useful adjunct during a range of neurosurgical procedures, especially tumor resections.

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Association between postoperative hypoalbuminemia and postoperative pulmonary imaging abnormalities patients undergoing craniotomy for brain tumors: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-00261-2 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Da-wei Zhao ◽

Feng-chun Zhao ◽

Xu-yang Zhang ◽

Kai-yan Wei ◽

Yi-bin Jiang ◽

...

Keyword(s):

Risk Factors ◽

Brain Tumor ◽

Brain Tumors ◽

Operation Time ◽

Tumor Surgery ◽

Regression Analyses ◽

Brain Tumor Surgery ◽

Pulmonary Imaging ◽

The Impact ◽

Preoperative Albumin

AbstractHypoalbuminemia is associated with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pulmonary imaging abnormalities had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pulmonary imaging abnormalities were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Pulmonary imaging abnormalities [OR 19.862 (95% CI 2.546–154.936, P = 0.004)] was a novel independent predictors of postoperative pneumonia. Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and may be associated with postoperative complications in patients undergoing brain tumor surgery.

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Change in Policy Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital

Operative Neurosurgery ◽

10.1093/ons/opz009 ◽

2019 ◽

Vol 17 (6) ◽

pp. 543-548

Author(s):

Anthony M DiGiorgio ◽

Praveen V Mummaneni ◽

Jonathan L Fisher ◽

Adam G Podet ◽

Clifford L Crutcher ◽

...

Keyword(s):

Length Of Stay ◽

Tertiary Care ◽

Wait Time ◽

Safety Net ◽

Medical Complications ◽

Neurosurgical Procedures ◽

Period 2 ◽

Safety Net Hospital ◽

The Impact ◽

Total Charges

Abstract BACKGROUND The practice of surgeons running overlapping operating rooms has recently come under scrutiny. OBJECTIVE To examine the impact of hospital policy allowing overlapping rooms in the case of patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS The neurosurgery service at the hospital being studied transitioned from routinely allowing 1 room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Demographics, indication, case type, complications, outcomes, and total charges were tracked. RESULTS There were 59 urgent cases in period 1 and 63 in period 2. In the case of these patients, the length of stay was significantly decreased in period 2 (13.09 d vs 19.52; P = .006). The time from admission to surgery (wait time) was also significantly decreased in period 2 (5.12 d vs 7.00; P = .04). Total charges also trended towards less in period 2 (${\$}$150 942 vs ${\$}$200 075; P = .05). Surgical complications were no different between the groups (16.9% vs 14.3%; P = .59), but medical complications were significantly decreased in period 2 (14.3% vs 30.5%; P = .009). Significantly more patients were discharged to home in period 2 (69.8% vs 42.4%; P = .003). CONCLUSION As a matter of policy, allowing overlapping rooms significantly reduces the length of stay in the case of a vulnerable population in need of urgent surgery at a single safety-net academic institution. This may be due to a reduction in medical complications in these patients.

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