Original ArticleSurgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes After Brain Tumor Resection
Introduction
Patients with brain tumors may present with either primary or metastatic disease, often requiring complex multidisciplinary care. Surgical management is often the initial management for these tumors because resection affords both diagnosis and therapeutic benefits. Although many factors affect patient outcome and overall survival after surgery, patient performance status is a crucial factor and one that is strongly influenced by surgical complications.1 With the increased focus on surgical quality and outcomes, surgeon experience and its effect on outcomes is appreciated as a priority area for health research. The modern assessment of surgical experience and its effect on outcomes can be traced back to the early 1990s, when the New York State Department of Health initiated a cardiac surgery registry to monitor short-term outcomes related to individual surgeons.2, 3 In the early 2000s, seminal studies by Birkmeyer et al.4, 5 highlighted the importance of the volume–outcome relationship in many surgical areas.
In surgical neuro-oncology, there are an increasing number of studies assessing volume–outcome relationships.6, 7, 8, 9 However, these studies have been cross-sectional and have not investigated the impact of accumulated experience on outcomes. Our recent studies have shown the importance of cumulative 5-year volume in rectal surgery and lack of accumulated surgery effect in cholecystectomy.10 Therefore, accumulated experience might be important in some surgical areas and not critical in others. The aim of this study was to determine if 5-year surgeon cumulative and annual volumes have an impact on early postoperative outcomes in patients with primary and metastatic brain tumors.
Section snippets
Data Source
Our study used the New York Statewide Planning and Research Cooperation System (SPARCS). Established in 1979, SPARCS is an all-payer database that collects patient-level data from every hospital discharge, ambulatory surgery, outpatient service, and emergency department admission in New York State. The data contain patient demographics, diagnoses, procedures, length of stay, outcomes, and charges. Patients are assigned with unique encrypted identifiers to allow for longitudinal studies.
Study Population
Patients
Results
Our study included 10,258 patients and 479 surgeons from New York State between 2005 and 2014 (Supplementary Figure 1). Patients were allocated into 4 distinct groups according to their surgeon's cumulative and annual volume, which were LC/LA, LC/HA, HC/LA, and HC/HA.
The number of annual brain tumor resections remained constant from 1034 in 2005 to 982 in 2014 (P = 0.39, Figure 1). There was a moderate increase in surgeries performed by HC/HA volume surgeons, from 46.5% to 50.3% (P = 0.02, see
Discussion
This is the first study to clarify the relationship of both cumulative and annual volume on postoperative patient outcomes after craniotomies for brain tumor resection. We used a comprehensive New York State cohort that included all patients undergoing surgery from 2005 to 2014. This data set was unique in that it provided for longitudinal analysis rather than the more standard cross-sectional assessment. This analysis allowed for the assessment of the effects of annual versus accumulated
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This work was funded by the Empire Clinical Research Investigators Program.