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The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States

OBJECT: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care (defined as the average annual number of neurosurgical procedures per capita) with morta...

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Autores principales: Missios, Symeon, Bekelis, Kimon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960180/
https://www.ncbi.nlm.nih.gov/pubmed/24647225
http://dx.doi.org/10.1371/journal.pone.0092057
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author Missios, Symeon
Bekelis, Kimon
author_facet Missios, Symeon
Bekelis, Kimon
author_sort Missios, Symeon
collection PubMed
description OBJECT: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care (defined as the average annual number of neurosurgical procedures per capita) with mortality, length of stay (LOS), and rate of unfavorable discharge for inpatients after neurosurgical procedures. METHODS: We performed a retrospective cohort study involving the 202,518 patients who underwent cranial neurosurgical procedures from 2005–2010 and were registered in the National Inpatient Sample (NIS) database. Regression techniques were used to investigate the association of the average intensity of neurosurgical care with the average mortality, LOS, and rate of unfavorable discharge. RESULTS: The inpatient neurosurgical mortality, rate of unfavorable discharge, and average LOS varied significantly among several states. In a multivariate analysis male gender, coverage by Medicaid, and minority racial status were associated with increased mortality, rate of unfavorable discharge, and LOS. The opposite was true for coverage by private insurance, higher income, fewer comorbidities and small hospital size. There was no correlation of the intensity of neurosurgical care with the mortality (Pearson's ρ = −0.18, P = 0.29), rate of unfavorable discharge (Pearson's ρ = 0.08, P = 0.62), and LOS of cranial neurosurgical procedures (Pearson's ρ = −0.21, P = 0.22). CONCLUSIONS: We observed significant disparities in mortality, LOS, and rate of unfavorable discharge for cranial neurosurgical procedures in the United States. Increased intensity of neurosurgical care was not associated with improved outcomes.
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spelling pubmed-39601802014-03-24 The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States Missios, Symeon Bekelis, Kimon PLoS One Research Article OBJECT: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care (defined as the average annual number of neurosurgical procedures per capita) with mortality, length of stay (LOS), and rate of unfavorable discharge for inpatients after neurosurgical procedures. METHODS: We performed a retrospective cohort study involving the 202,518 patients who underwent cranial neurosurgical procedures from 2005–2010 and were registered in the National Inpatient Sample (NIS) database. Regression techniques were used to investigate the association of the average intensity of neurosurgical care with the average mortality, LOS, and rate of unfavorable discharge. RESULTS: The inpatient neurosurgical mortality, rate of unfavorable discharge, and average LOS varied significantly among several states. In a multivariate analysis male gender, coverage by Medicaid, and minority racial status were associated with increased mortality, rate of unfavorable discharge, and LOS. The opposite was true for coverage by private insurance, higher income, fewer comorbidities and small hospital size. There was no correlation of the intensity of neurosurgical care with the mortality (Pearson's ρ = −0.18, P = 0.29), rate of unfavorable discharge (Pearson's ρ = 0.08, P = 0.62), and LOS of cranial neurosurgical procedures (Pearson's ρ = −0.21, P = 0.22). CONCLUSIONS: We observed significant disparities in mortality, LOS, and rate of unfavorable discharge for cranial neurosurgical procedures in the United States. Increased intensity of neurosurgical care was not associated with improved outcomes. Public Library of Science 2014-03-19 /pmc/articles/PMC3960180/ /pubmed/24647225 http://dx.doi.org/10.1371/journal.pone.0092057 Text en © 2014 Missios, Bekelis http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Missios, Symeon
Bekelis, Kimon
The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States
title The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States
title_full The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States
title_fullStr The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States
title_full_unstemmed The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States
title_short The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States
title_sort association of unfavorable outcomes with the intensity of neurosurgical care in the united states
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960180/
https://www.ncbi.nlm.nih.gov/pubmed/24647225
http://dx.doi.org/10.1371/journal.pone.0092057
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