Abstract:
:OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p < 0.001); African American (OR 1.75, 95% CI 1.44%-2.14%, p < 0.001) and Hispanic (OR 1.68, 95% CI 1.36%-2.08%) race or ethnicity; ASA class 3 (OR 1.52, 95% CI 1.34%-1.73%) or 4-5 (OR 2.18, 95% CI 1.82%-2.62%) designation; partially (OR 1.94, 95% CI 1.61%-2.35%) or totally dependent (OR 3.30, 95% CI 1.95%-5.55%) functional status; insulin-dependent diabetes mellitus (OR 1.46, 95% CI 1.16%-1.84%); hematological comorbidities (OR 1.68, 95% CI 1.25%-2.24%); and preoperative hypoalbuminemia (OR 1.78, 95% CI 1.51%-2.09%, all p ≤ 0.009). Several postoperative complications were additional independent predictors of prolonged hospitalization including pulmonary emboli (OR 13.75, 95% CI 4.73%-39.99%), pneumonia (OR 5.40, 95% CI 2.89%-10.07%), and urinary tract infections (OR 11.87, 95% CI 7.09%-19.87%, all p < 0.001). The C-statistic of the model based on preoperative characteristics was 0.79, which increased to 0.83 after the addition of postoperative complications. A length of stay after craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p < 0.001). Extended hospital stay was not associated with differential odds of an unplanned hospital readmission (OR 0.97, 95% CI 0.89%-1.06%, p = 0.55). CONCLUSIONS In this NSQIP analysis that evaluated patients who underwent craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated with differential rates of unplanned readmission.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Dasenbrock HH,Liu KX,Devine CA,Chavakula V,Smith TR,Gormley WB,Dunn IFdoi
10.3171/2015.10.FOCUS15386subject
Has Abstractpub_date
2015-12-01 00:00:00pages
E12issue
6issn
1092-0684journal_volume
39pub_type
杂志文章abstract::The authors describe the case of a boy with Muenke syndrome, an autosomal dominant disorder associated with craniosynostosis. The family history was significant for syndromic craniosynostosis in the patient's maternal grandmother, who died in adulthood after a craniofacial reconstruction. The patient, her grandson, un...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.2.FOCUS151
更新日期:2015-05-01 00:00:00
abstract:OBJECT:The goal of this study was to evaluate the definition of treatment-resistant depression (TRD), review the literature regarding deep brain stimulation (DBS) for TRD, and identify potential anatomical and functional targets for future widespread clinical application. METHODS:A comprehensive literature review was ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC/2008/25/7/E3
更新日期:2008-01-01 00:00:00
abstract::A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.2.4
更新日期:2002-08-15 00:00:00
abstract::Hypothalamic hamartomas are uncommon but well-recognized developmental malformations that are classically associated with gelastic seizures and other refractory seizure types. The clinical course is often progressive and, in addition to the catastrophic epileptic syndrome, patients commonly exhibit debilitating cognit...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.3.FOCUS1355
更新日期:2013-06-01 00:00:00
abstract::Giant cerebral aneurysms may be treated through a variety of options, including aneurysm trapping with concurrent bypass. This video describes the case of a large, recurrent, left middle cerebral artery aneurysm that was treated using a high flow, radial artery bypass graft, from the external carotid artery to the lef...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.V1.FOCUS14548
更新日期:2015-01-01 00:00:00
abstract::Stereotactic radiosurgery is an effective management strategy for properly selected patients with arteriovenous malformations (AVMs). However, the risk of postradiosurgical radiation-related injury is higher in patients with large AVMs. Multistaged volumetric management of large AVMs was undertaken to limit the radiat...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2014.6.FOCUS14217
更新日期:2014-09-01 00:00:00
abstract:OBJECT:The direct transnasal transsphenoidal approach to the sellar region has become a widely adopted surgical procedure among neurosurgeons and ear, nose, and throat specialists. Nasal complications and their incidence have been investigated, but a systematic testing of olfactory disturbance has not previously been p...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.7.FOCUS10162
更新日期:2010-10-01 00:00:00
abstract::OBJECTIVE The authors describe their results using an endoscope as an adjunct to microsurgical resection of inferior vestibular schwannomas (VSs) with extension into the fundus of the internal auditory canal below the transverse crest. METHODS All patients who had undergone middle fossa craniotomy for VSs performed by...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.12.FOCUS17663
更新日期:2018-03-01 00:00:00
abstract::Surgery of the mind has a rather checkered past. Though its history begins with the prehistoric trephination of skulls to allow "evil spirits" to escape, the early- to mid-20th century saw a surge in the popularity of psychosurgery. The 2 prevailing operations were topectomy and leukotomy for the treatment of certain ...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2017.6.FOCUS17259
更新日期:2017-09-01 00:00:00
abstract::For a physician has the worth of many other warriors, both for the excision of arrows and for the administration of soothing drugs. Homer, Iliad XI.514-515 Ever since armed conflict has been used as a means to settle disputes among men, there have been those who have been tasked to mend the wounds that ravage a soldie...
journal_title:Neurosurgical focus
pub_type: 历史文章
doi:10.3171/2010.3.FOCUSMar2010Intro
更新日期:2010-05-01 00:00:00
abstract::Cerebral edema is frequently encountered in clinical practice in critically ill patients with acute brain injury from diverse origins and is a major cause of increased morbidity and death in this subset of patients. The consequences of cerebral edema can be lethal and include cerebral ischemia from compromised regiona...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.22.5.13
更新日期:2007-05-15 00:00:00
abstract::Cysticercosis is the most common parasitic infection of the central nervous system. It infrequently affects the spine, but when it does, it can present with symptoms similar to other more common spinal diseases. The authors present a case of isolated intramedullary cysticercosis of the cervical spine and review the li...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.12.6.11
更新日期:2002-06-15 00:00:00
abstract:OBJECT:Clinoidal meningiomas remain a major neurosurgical challenge. Surgery-related outcome has been less than desirable in the past, and little attention has been directed toward improving visual deficits. The authors advocate a skull base technique for the removal of these difficult tumors and describe its advantage...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2003.14.6.5
更新日期:2003-06-15 00:00:00
abstract::Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no par...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.6.FOCUS1192
更新日期:2011-08-01 00:00:00
abstract:OBJECT:Mild traumatic brain injury (MTBI), often referred to as concussion when it occurs in sports, produces persistent cognitive problems in at least 15% of patients. Unfortunately, conventional neuropsychological tests usually yield results within normal limits in this population. The main objective of this event-re...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2012.10.FOCUS12253
更新日期:2012-12-01 00:00:00
abstract::Choroid plexus tumors consist of papillomas and carcinomas. A variety of germline and somatic genetic changes have been demonstrated for each of these subtypes. In this paper, the authors summarize the current knowledge of the genetic bases of these tumors. ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2006.20.1.11
更新日期:2006-01-15 00:00:00
abstract:OBJECT:The safety and effectiveness of osteogenic protein (OP)-1 putty (recombinant human bone morphogenetic protein-7) in promoting fusion in complex spinal cases was studied in nine cases. METHODS:The authors prospectively evaluated nine patients requiring spinal fusion in whom there were medical risk factors that w...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.6.5
更新日期:2002-12-15 00:00:00
abstract:OBJECTIVE:Acute traumatic subdural hematoma (atSDH) can be a life-threatening neurosurgical emergency that necessitates immediate evacuation. The elderly population can be particularly vulnerable to tearing bridging veins. The aim of this study was to evaluate inpatient morbidity and mortality, as well as predictors of...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.7.FOCUS20439
更新日期:2020-10-01 00:00:00
abstract::Intracranial electroencephalography monitoring of the insula is an important tool in the investigation of the insula in medically intractable epilepsy and has been shown to be safe and reliable. Several methods of placing electrodes for insular coverage have been reported and include open craniotomy as well as stereot...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2012.1.FOCUS11325
更新日期:2012-03-01 00:00:00
abstract:OBJECT:Nowadays the role of microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue, minimizing the postoperative morbidity. The purpose of this paper was to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2009.11.FOCUS09234
更新日期:2010-02-01 00:00:00
abstract::Sacral fractures are uncommon lesions and most often the result of high-energy trauma. Depending on the fracture location, neurological injury may be present in over 50% of cases. In this article, the authors conducted a comprehensive literature review on the epidemiology of sacral fractures, relevant anatomy of the s...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2014.5.FOCUS1474
更新日期:2014-01-01 00:00:00
abstract::OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between Janua...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.11.FOCUS16348
更新日期:2017-03-01 00:00:00
abstract::OBJECTIVE The long-term effects on adjacent-segment pathology after nonfusion dynamic stabilization is unclear, and, in particular, changes at the adjacent facet joints have not been reported in a clinical study. This study aims to compare changes in the adjacent facet joints after lumbar spinal surgery. METHODS Patie...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.10.FOCUS15456
更新日期:2016-01-01 00:00:00
abstract::Surgery for cranial deformity was associated with significant surgical morbidity during the early part of the 20th century. For this reason, Harvey Cushing was initially not in favor of surgical treatment of craniosynostosis. Later in his career, Cushing began to operate on these children, although it never became a m...
journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
doi:10.3171/2010.9.FOCUS10191
更新日期:2010-12-01 00:00:00
abstract:OBJECT:The goal of this study was to review the management of intra- and extradural ependymomas. Spinal ependymomas most commonly occur as intramedullary tumors throughout the spinal axis. In the lumbosacral region, ependymomas are most commonly associated with the conus medullaris and cauda equina, but can also occur ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.15.5.13
更新日期:2003-11-15 00:00:00
abstract:OBJECTIVE:Nonfunctioning pituitary adenomas present without biochemical or clinical signs of hormone excess and are the second most common type of pituitary adenomas. The 2017 WHO classification scheme of pituitary adenomas differentiates null-cell adenomas (NCAs) and silent gonadotroph adenomas (SGAs). The present stu...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.3.FOCUS20114
更新日期:2020-06-01 00:00:00
abstract:OBJECT:The authors performed a retrospective study to assess the impact of functional neuronavigation and intraoperative MRI (iMRI) on surgery of extratemporal epileptogenic lesions on postsurgical morbidity and seizure control. METHODS:Twenty-five patients (14 females and 11 males) underwent extratemporal resections ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2013.2.FOCUS12397
更新日期:2013-04-01 00:00:00
abstract::Primary central nervous system lymphoma (PCNSL) is an aggressive neoplastic process that occurs in both immunocompetent and immunocompromised patients. Over the past 30 years there has been a steady increase in the number of cases in both patient populations. The imaging features for the disease and demographic charac...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2006.21.5.5
更新日期:2006-11-15 00:00:00
abstract::Since the earliest recorded history of medicine, physicians have been challenged by the difficulty in relieving the great pain experienced by individuals suffering from trigeminal neuralgia (TN). The nature of the pain and the events that incite it have been well described, but effective treatments with acceptable lev...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/foc.2005.18.5.5
更新日期:2005-05-15 00:00:00
abstract::The author addresses the issue of neurofibroma classification and implications for treatment. He emphasizes the importance of understanding that not all neurofibromas are the same and that the key differences between the types of neurofibromas involve which portions of the nerve sheath contribute to the distinctive be...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.22.6.4
更新日期:2007-06-15 00:00:00