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Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma.

ABSTRACT: BACKGROUND:Extent of resection (EOR) is well established as correlating with overall survival in patients with glioblastoma (GBM). The impact of EOR on reported quality metrics such as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) is unknown. OBJECTIVE:To perform a retrospective study to evaluate possible associations between EOR and the incidence of PSIs and HACs. METHODS:We queried all patients diagnosed with GBM who underwent surgical resection at our institution between January 2011 and May 2017. Pre- and postoperative magnetic resonance images were analyzed for EOR. Each chart was reviewed to determine the incidence of PSIs and HACs. RESULTS:A total of 284 patients met the inclusion criteria. EOR ranged from 39.00 to 100%, with a median of 99.84% and a mean of 95.7%. There were 16 PSI, and 13 HAC, events. There were no significant differences in the rates of PSIs or HACs when compared between patients stratified by gross total resection (EOR ? 95%) and subtotal resection (EOR < 95%). The odds of encountering a PSI or HAC were 2.5 times more likely in the subtotal resection group compared to the gross total resection group (P = .58). After adjusting for confounders, the odds of encountering a PSI or HAC in the subtotal resection group were 3.9 times greater than for the gross total resection group (P < .05). CONCLUSION:Gross total resection of GBM is associated with a decreased incidence of PSIs and HACs, as compared to subtotal resection.

SUBMITTER: Laurent D

PROVIDER: S-EPMC7594111 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma.

Laurent Dimitri D Freedman Rachel R Cope Logan L Sacks Patricia P Abbatematteo Joe J Kubilis Paul P Bova Frank F Rahman Maryam M

Neurosurgery 20200501 5

<h4>Background</h4>Extent of resection (EOR) is well established as correlating with overall survival in patients with glioblastoma (GBM). The impact of EOR on reported quality metrics such as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) is unknown.<h4>Objective</h4>To perform a retrospective study to evaluate possible associations between EOR and the incidence of PSIs and HACs.<h4>Methods</h4>We queried all patients diagnosed with GBM who underwent surgical resection ...[more]

PMID: 31342060

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Project description:BackgroundPostoperative complications after major gastrointestinal surgery are a major contributor to hospital costs. Thus, reducing postoperative complications is a key target for cost-containment strategies. We aimed to evaluate the relationship between postoperative complications and hospital costs following small bowel resection.MethodsPostoperative complications were recorded for 284 adult patients undergoing major small bowel resection surgery between January 2013 and June 2018. Complications were defined and graded according to the Clavien-Dindo classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology; it was reported in US dollars at 2019 rates. Regression modeling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs.FindingsThe overall complication prevalence was 81.6% (95% CI: 85.7-77.5). Most complications (69%) were minor, but 22.9% of patients developed a severe complication (Clavien-Dindo grades III or IV). The unadjusted median total hospital cost for patients with any complication was 70% higher than patients without complications (median [IQR] USD 19,659.64 [13,545.81-35,407.14] vs. 11,551.88 [8,849.46-15,329.87], P < 0.001). The development of 1, 2, 3, and ≥ 4 complications increased hospital costs by 11%, 41%, 50%, and 195%, respectively. Similarly, more severe complications incurred higher hospital costs (P < 0.001). After adjustments were made (for the Charlson Comorbidity Index, anemia, surgical urgency and technique, intraoperative fluid administration, blood transfusion, and hospital readmissions), a greater number and increased severity of complications were associated with a higher adjusted median hospital cost. Patients who experienced complications had an adjusted additional median cost of USD 4,187.10 (95% CI: 1,264.89-7,109.31, P = 0.005) compared to those without complications.ConclusionsPostoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following small bowel resection surgery and quantify their associated increase in hospital costs.Trial registrationAustralian Clinical Trials Registration number: 12620000322932.

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Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma.

Publications

Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma.

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