Pediatric primary brain tumors are the leading cause of death among childhood cancers. Guidelines recommend specialized care with a multidisciplinary team and focused treatment protocols to optimize outcomes in this patient population. Furthermore, readmission is a key metric of patient outcomes and has been used to inform reimbursement. However, no prior study has analyzed national database–level records to evaluate the role of care in a designated children’s hospital following pediatric tumor resection and its impact on readmission rates. The goal of this study was to investigate whether treatment at a children’s hospital rather than a nonchildren’s hospital has a significant effect on outcome.
开云体育世界杯赔率
The Nationwide Readmissions Database records from 2010 to 2018 were analyzed retrospectively to evaluate the effect of hospital designation on patient outcomes after craniotomy for brain tumor resection, and results are reported as national estimates. Univariate and multivariate regression analyses of patient and hospital characteristics were conducted to evaluate if craniotomy for tumor resection at a designated children’s hospital was independently associated with 30-day readmissions, mortality rate, and length of stay.
RESULTS
A total of 4003 patients who underwent craniotomy for tumor resection were identified using the Nationwide Readmissions Database, with 1258 of these cases (31.4%) treated at children’s hospitals. Patients treated at children’s hospitals were associated with decreased likelihood of 30-day hospital readmission (OR 0.68, 95% CI 0.48–0.97, p = 0.036) compared to patients treated at nonchildren’s hospitals. There was no significant difference in index mortality between patients treated at children’s hospitals and those treated at nonchildren’s hospitals.
CONCLUSIONS
The authors found that patients undergoing craniotomy for tumor resection at children’s hospitals were associated with decreased rates of 30-day readmission, with no significant difference in index mortality. Future prospective studies may be warranted to confirm this association and identify components contributing to improved outcomes in care at children’s hospitals.
ABBREVIATIONS
APR-DRG = all patient refined diagnosis-related group;CCC = complex chronic condition;ICD-9-CM and ICD-10-CM = International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification;IRR = incident rate ratio;LOS = length of stay;NACHRI = National Association of Children’s Hospitals and Related Institutions;NRD = Nationwide Readmissions Database.
OstromQT,PatilN,CioffiG,WaiteK,KruchkoC,Barnholtz-SloanJS.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.
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
.)| false
HillnerBE,SmithTJ,DeschCE.何spital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care.J Clin Oncol.2000;18(11):2327–2340.
Hillner
BE
,
Smith
TJ
,
Desch
CE
.
何spital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care
.J Clin Oncol
.
2000
;
18
(
11
):
2327
–
2340
.)| false
DynanL,GoudieA,SmithRB,FairbrotherG,SimpsonLA.Differences in quality of care among non-safety-net, safety-net, and children’s hospitals.Pediatrics.2013;131(2):304–311.
Dynan
L
,
Goudie
A
,
Smith
RB
,
Fairbrother
G
,
Simpson
LA
.
Differences in quality of care among non-safety-net, safety-net, and children’s hospitals
.Pediatrics
.
2013
;
131
(
2
):
304
–
311
.)| false
奥尔布赖特AL,SpostoR,何lmesE,et al.Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors.开云体育app官方网站下载入口.2000;47(4):879–887.
奥尔布赖特
AL
,
Sposto
R
,
何lmes
E
,
Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors
.开云体育app官方网站下载入口
.
2000
;
47
(
4
):
879
–
887
.)| false
SmithER,ButlerWE,BarkerFGII.Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care.开云体育app官方网站下载入口.2004;54(3):553–565.
Smith
ER
,
Butler
WE
,
Barker
FG
II
.
Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care
.开云体育app官方网站下载入口
.
2004
;
54
(
3
):
553
–
565
.)| false
DurhamSR,LaneJR,ShipmanSA.The pediatric neurosurgical workforce: defining the current supply Clinical article.J Neurosurg Pediatr.2009;3(1):1–10.
Durham
SR
,
Lane
JR
,
Shipman
SA
.
The pediatric neurosurgical workforce: defining the current supply Clinical article
.J Neurosurg Pediatr
.
2009
;
3
(
1
):
1
–
10
.)| false
AhmedAK,DuhaimeAC,SmithTR.Geographic proximity to specialized pediatric neurosurgical care in the contiguous United States.J Neurosurg Pediatr.2018;21(4):434–438.
Ahmed
AK
,
Duhaime
AC
,
Smith
TR
.
Geographic proximity to specialized pediatric neurosurgical care in the contiguous United States
.J Neurosurg Pediatr
.
2018
;
21
(
4
):
434
–
438
.)| false
DonohoDA,WenT,BabadjouniRM,et al.Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data.J Neurooncol.2018;136(1):87–94.
Donoho
DA
,
Wen
T
,
Babadjouni
RM
,
Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data
.J Neurooncol
.
2018
;
136
(
1
):
87
–
94
.)| false
HauserA,DuttaSW,ShowalterTN,SheehanJP,GroverS,TrifilettiDM.Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma.J Clin Neurosci.2018;47:103–110.
Hauser
A
,
Dutta
SW
,
Showalter
TN
,
Sheehan
JP
,
Grover
S
,
Trifiletti
DM
.
Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma
.J Clin Neurosci
.
2018
;
47
:
103
–
110
.)| false
FinlaysonEV,GoodneyPP,BirkmeyerJD.何spital volume and operative mortality in cancer surgery: a national study.Arch Surg.2003;138(7):721–726.
Finlayson
EV
,
Goodney
PP
,
Birkmeyer
JD
.
何spital volume and operative mortality in cancer surgery: a national study
.Arch Surg
.
2003
;
138
(
7
):
721
–
726
.)| false
BirkmeyerJD,StukelTA,SiewersAE,GoodneyPP,WennbergDE,LucasFL.Surgeon volume and operative mortality in the United States.N Engl J Med.2003;349(22):2117–2127.
Birkmeyer
JD
,
Stukel
TA
,
Siewers
AE
,
Goodney
PP
,
Wennberg
DE
,
Lucas
FL
.
Surgeon volume and operative mortality in the United States
.N Engl J Med
.
2003
;
349
(
22
):
2117
–
2127
.)| false
CowanJAJr,DimickJB,LevequeJC,ThompsonBG,UpchurchGRJr,何ffJT.The impact of provider volume on mortality after intracranial tumor resection.开云体育app官方网站下载入口.2003;52(1):48–54.
Cowan
JA
Jr
,
Dimick
JB
,
Leveque
JC
,
Thompson
BG
,
Upchurch
GR
Jr
,
何ff
JT
.
The impact of provider volume on mortality after intracranial tumor resection
.开云体育app官方网站下载入口
.
2003
;
52
(
1
):
48
–
54
.)| false
McAteerJP,LaRiviereCA,DrugasGT,AbdullahF,OldhamKT,GoldinAB.Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review.JAMA Pediatr.2013;167(5):468–475.
McAteer
JP
,
LaRiviere
CA
,
Drugas
GT
,
Abdullah
F
,
Oldham
KT
,
Goldin
AB
.
Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review
.JAMA Pediatr
.
2013
;
167
(
5
):
468
–
475
.)| false
BuchananCC,HernandezEA,AndersonJM,et al.Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement.J Neurosurg.2014;121(1):170–175.
Buchanan
CC
,
Hernandez
EA
,
Anderson
JM
,
Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement
.J Neurosurg
.
2014
;
121
(
1
):
170
–
175
.)| false
SherrodBA,JohnstonJM,RocqueBG.Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.J Neurosurg Pediatr.2016;18(3):350–362.
Sherrod
BA
,
Johnston
JM
,
Rocque
BG
.
Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program
.J Neurosurg Pediatr
.
2016
;
18
(
3
):
350
–
362
.)| false
SanderC,OppermannH,NestlerU,SanderK,von DercksN,MeixensbergerJ.Causes and predictors of unplanned readmission in cranial neurosurgery.World Neurosurg.2021;149:e622–e635.
Sander
C
,
Oppermann
H
,
Nestler
U
,
Sander
K
,
von Dercks
N
,
Meixensberger
J
.
Causes and predictors of unplanned readmission in cranial neurosurgery
.World Neurosurg
.
2021
;
149
:
e622
–
e635
.)| false
何enkK,TornoL,FeasterW,et al.Multicenter study of risk factors of unplanned 30-day readmissions in pediatric oncology.Cancer Rep (Hoboken).2021;4(3):e1343.
何enk
K
,
Torno
L
,
Feaster
W
,
Multicenter study of risk factors of unplanned 30-day readmissions in pediatric oncology
.Cancer Rep (Hoboken)
.
2021
;
4
(
3
):
e1343
.)| false
MarcusLP,McCutcheonBA,NoorbakhshA,et al.Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010).J Neurosurg.2014;120(5):1201–1211.
Marcus
LP
,
McCutcheon
BA
,
Noorbakhsh
A
,
Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010)
.J Neurosurg
.
2014
;
120
(
5
):
1201
–
1211
.)| false
Agency for Healthcare Research and Quality
.
NRD Overview. Modified November 23, 2022. Accessed May 8, 2023.
www.hcup-us.ahrq.gov/nrdoverview.jsp)| false
AlayonAL,HagertyV,何spedalesE,et al.Impact of insurance status, hospital ownership type, and children’s hospital designation on outcomes for pediatric neurosurgery patients following spasticity procedures in the USA.Childs Nerv Syst.2021;37(12):3881–3889.
Alayon
AL
,
Hagerty
V
,
何spedales
E
,
Impact of insurance status, hospital ownership type, and children’s hospital designation on outcomes for pediatric neurosurgery patients following spasticity procedures in the USA
.Childs Nerv Syst
.
2021
;
37
(
12
):
3881
–
3889
.)| false
SamuelsS,KimballR,HagertyV,LeveneT,LeveneHB,SpaderH.Association of hospital characteristics with outcomes for pediatric neurosurgical accidental trauma patients.J Neurosurg Pediatr.2021;27(6):637–642.
Samuels
S
,
Kimball
R
,
Hagerty
V
,
Levene
T
,
Levene
HB
,
Spader
H
.
Association of hospital characteristics with outcomes for pediatric neurosurgical accidental trauma patients
.J Neurosurg Pediatr
.
2021
;
27
(
6
):
637
–
642
.)| false
DrapeauAI,OnwukaA,KopperaS,LeonardJR.何spital case-volume and patient outcomes following pediatric brain tumor surgery in the pediatric health information system.Pediatr Neurol.2022;133:48–54.
Drapeau
AI
,
Onwuka
A
,
Koppera
S
,
Leonard
JR
.
何spital case-volume and patient outcomes following pediatric brain tumor surgery in the pediatric health information system
.Pediatr Neurol
.
2022
;
133
:
48
–
54
.)| false
DiopH,CuiX,NielsenT,Peacock-ChambersE,GuptaM.Length of stay among infants with neonatal abstinence syndrome and risk of hospital readmission.Matern Child Health J.2022;26(10):2020–2029.
Diop
H
,
Cui
X
,
Nielsen
T
,
Peacock-Chambers
E
,
Gupta
M
.
Length of stay among infants with neonatal abstinence syndrome and risk of hospital readmission
.Matern Child Health J
.
2022
;
26
(
10
):
2020
–
2029
.)| false
哈桑M,DiepD,ManoranjanB,et al.Analysis of factors that influence neurosurgical length of hospital stay among newly diagnosed pediatric brain tumor patients.Pediatr Blood Cancer.2020;67(1):e28041.
哈桑
M
,
Diep
D
,
Manoranjan
B
,
Analysis of factors that influence neurosurgical length of hospital stay among newly diagnosed pediatric brain tumor patients
.Pediatr Blood Cancer
.
2020
;
67
(
1
):
e28041
.)| false
LagerwaardFJ,LevendagPC,NowakPJ,EijkenboomWM,HanssensPE,SchmitzPI.Identification of prognostic factors in patients with brain metastases: a review of 1292 patients.Int J Radiat Oncol Biol Phys.1999;43(4):795–803.
Lagerwaard
FJ
,
Levendag
PC
,
Nowak
PJ
,
Eijkenboom
WM
,
Hanssens
PE
,
Schmitz
PI
.
Identification of prognostic factors in patients with brain metastases: a review of 1292 patients
.Int J Radiat Oncol Biol Phys
.
1999
;
43
(
4
):
795
–
803
.)| false
MahaleyMSJr,MettlinC,NatarajanN,LawsERJr,PeaceBB.National survey of patterns of care for brain-tumor patients.J Neurosurg.1989;71(6):826–836.
Mahaley
MS
Jr
,
Mettlin
C
,
Natarajan
N
,
Laws
ER
Jr
,
Peace
BB
.
National survey of patterns of care for brain-tumor patients
.J Neurosurg
.
1989
;
71
(
6
):
826
–
836
.)| false
SimpsonJR,何rtonJ,ScottC,et al.Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials.Int J Radiat Oncol Biol Phys.1993;26(2):239–244.
Simpson
JR
,
何rton
J
,
Scott
C
,
Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials
.Int J Radiat Oncol Biol Phys
.
1993
;
26
(
2
):
239
–
244
.)| false
SurawiczTS,DavisF,FreelsS,LawsERJr,MenckHR.Brain tumor survival: results from the National Cancer Data Base.J Neurooncol.1998;40(2):151–160.
Surawicz
TS
,
Davis
F
,
Freels
S
,
Laws
ER
Jr
,
Menck
HR
.
Brain tumor survival: results from the National Cancer Data Base
.J Neurooncol
.
1998
;
40
(
2
):
151
–
160
.)| false
