TY - JOUR
T1 - Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery
AU - Hamer, Philip C. De Witt
AU - Ho, Vincent K. Y.
AU - Zwinderman, Aeilko H.
AU - Ackermans, Linda
AU - Ardon, Hilko
AU - Boomstra, Sytske
AU - Bouwknegt, Wim
AU - van den Brink, Wimar A.
AU - Dirven, Clemens M.
AU - van der Gaag, Niels A.
AU - van der Veer, Olivier
AU - Idema, Albert J. S.
AU - Kloet, Alfred
AU - Koopmans, Jan
AU - ter Laan, Mark
AU - Verstegen, Marco J. T.
AU - Wagemakers, Michiel
AU - Robe, Pierre A. J. T.
AU - Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery
N1 - Funding Information:
The authors express their gratitude for the valuable comments by David Spiegelhalter (Statistical Laboratory, Centre for Mathematical Sciences, University of Cambridge, United Kingdom), William P. Vandertop and David P. Noske (Neurosurgical Center Amsterdam, Netherlands) on the manuscript.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/9
Y1 - 2019/9
N2 - Purpose Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34-3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.
AB - Purpose Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34-3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.
KW - Glioblastoma
KW - Neurosurgical procedures
KW - Quality of health care
KW - Outcome assessment
KW - Mortality
KW - Survival
KW - NEWLY-DIAGNOSED GLIOBLASTOMA
KW - UNITED-STATES
KW - TEMOZOLOMIDE ERA
KW - ELDERLY-PATIENTS
KW - PHASE-III
KW - CARE
KW - PATTERNS
KW - RESECTION
KW - OUTCOMES
KW - GLIOMA
U2 - 10.1007/s11060-019-03229-5
DO - 10.1007/s11060-019-03229-5
M3 - Article
C2 - 31236819
SN - 0167-594X
VL - 144
SP - 313
EP - 323
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 2
ER -