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Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery

INTRODUCTION: For decisions on glioblastoma surgery, the risk of complications and decline in performance is decisive. In this study, we determine the rate of complications and performance decline after resections and biopsies in a national quality registry, their risk factors and the risk-standardi...

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Autores principales: Kommers, Ivar, Ackermans, Linda, Ardon, Hilko, van den Brink, Wimar A., Bouwknegt, Wim, Balvers, Rutger K., van der Gaag, Niels, Bosscher, Lisette, Kloet, Alfred, Koopmans, Jan, Laan, Mark ter, Tewarie, Rishi Nandoe, Robe, Pierre A., van der Veer, Olivier, Wagemakers, Michiel, Zwinderman, Aeilko H., De Witt Hamer, Philip C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997839/
https://www.ncbi.nlm.nih.gov/pubmed/33511509
http://dx.doi.org/10.1007/s11060-021-03697-8
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author Kommers, Ivar
Ackermans, Linda
Ardon, Hilko
van den Brink, Wimar A.
Bouwknegt, Wim
Balvers, Rutger K.
van der Gaag, Niels
Bosscher, Lisette
Kloet, Alfred
Koopmans, Jan
Laan, Mark ter
Tewarie, Rishi Nandoe
Robe, Pierre A.
van der Veer, Olivier
Wagemakers, Michiel
Zwinderman, Aeilko H.
De Witt Hamer, Philip C.
author_facet Kommers, Ivar
Ackermans, Linda
Ardon, Hilko
van den Brink, Wimar A.
Bouwknegt, Wim
Balvers, Rutger K.
van der Gaag, Niels
Bosscher, Lisette
Kloet, Alfred
Koopmans, Jan
Laan, Mark ter
Tewarie, Rishi Nandoe
Robe, Pierre A.
van der Veer, Olivier
Wagemakers, Michiel
Zwinderman, Aeilko H.
De Witt Hamer, Philip C.
author_sort Kommers, Ivar
collection PubMed
description INTRODUCTION: For decisions on glioblastoma surgery, the risk of complications and decline in performance is decisive. In this study, we determine the rate of complications and performance decline after resections and biopsies in a national quality registry, their risk factors and the risk-standardized variation between institutions. METHODS: Data from all 3288 adults with first-time glioblastoma surgery at 13 hospitals were obtained from a prospective population-based Quality Registry Neuro Surgery in the Netherlands between 2013 and 2017. Patients were stratified by biopsies and resections. Complications were categorized as Clavien-Dindo grades II and higher. Performance decline was considered a deterioration of more than 10 Karnofsky points at 6 weeks. Risk factors were evaluated in multivariable logistic regression analysis. Patient-specific expected and observed complications and performance declines were summarized for institutions and analyzed in funnel plots. RESULTS: For 2271 resections, the overall complication rate was 20 % and 16 % declined in performance. For 1017 biopsies, the overall complication rate was 11 % and 30 % declined in performance. Patient-related characteristics were significant risk factors for complications and performance decline, i.e. higher age, lower baseline Karnofsky, higher ASA classification, and the surgical procedure. Hospital characteristics, i.e. case volume, university affiliation and biopsy percentage, were not. In three institutes the observed complication rate was significantly less than expected. In one institute significantly more performance declines were observed than expected, and in one institute significantly less. CONCLUSIONS: Patient characteristics, but not case volume, were risk factors for complications and performance decline after glioblastoma surgery. After risk-standardization, hospitals varied in complications and performance declines. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-021-03697-8.
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spelling pubmed-79978392021-04-16 Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery Kommers, Ivar Ackermans, Linda Ardon, Hilko van den Brink, Wimar A. Bouwknegt, Wim Balvers, Rutger K. van der Gaag, Niels Bosscher, Lisette Kloet, Alfred Koopmans, Jan Laan, Mark ter Tewarie, Rishi Nandoe Robe, Pierre A. van der Veer, Olivier Wagemakers, Michiel Zwinderman, Aeilko H. De Witt Hamer, Philip C. J Neurooncol Clinical Study INTRODUCTION: For decisions on glioblastoma surgery, the risk of complications and decline in performance is decisive. In this study, we determine the rate of complications and performance decline after resections and biopsies in a national quality registry, their risk factors and the risk-standardized variation between institutions. METHODS: Data from all 3288 adults with first-time glioblastoma surgery at 13 hospitals were obtained from a prospective population-based Quality Registry Neuro Surgery in the Netherlands between 2013 and 2017. Patients were stratified by biopsies and resections. Complications were categorized as Clavien-Dindo grades II and higher. Performance decline was considered a deterioration of more than 10 Karnofsky points at 6 weeks. Risk factors were evaluated in multivariable logistic regression analysis. Patient-specific expected and observed complications and performance declines were summarized for institutions and analyzed in funnel plots. RESULTS: For 2271 resections, the overall complication rate was 20 % and 16 % declined in performance. For 1017 biopsies, the overall complication rate was 11 % and 30 % declined in performance. Patient-related characteristics were significant risk factors for complications and performance decline, i.e. higher age, lower baseline Karnofsky, higher ASA classification, and the surgical procedure. Hospital characteristics, i.e. case volume, university affiliation and biopsy percentage, were not. In three institutes the observed complication rate was significantly less than expected. In one institute significantly more performance declines were observed than expected, and in one institute significantly less. CONCLUSIONS: Patient characteristics, but not case volume, were risk factors for complications and performance decline after glioblastoma surgery. After risk-standardization, hospitals varied in complications and performance declines. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-021-03697-8. Springer US 2021-01-28 2021 /pmc/articles/PMC7997839/ /pubmed/33511509 http://dx.doi.org/10.1007/s11060-021-03697-8 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Clinical Study
Kommers, Ivar
Ackermans, Linda
Ardon, Hilko
van den Brink, Wimar A.
Bouwknegt, Wim
Balvers, Rutger K.
van der Gaag, Niels
Bosscher, Lisette
Kloet, Alfred
Koopmans, Jan
Laan, Mark ter
Tewarie, Rishi Nandoe
Robe, Pierre A.
van der Veer, Olivier
Wagemakers, Michiel
Zwinderman, Aeilko H.
De Witt Hamer, Philip C.
Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery
title Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery
title_full Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery
title_fullStr Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery
title_full_unstemmed Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery
title_short Between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch Quality Registry Neuro Surgery
title_sort between‐hospital variation in rates of complications and decline of patient performance after glioblastoma surgery in the dutch quality registry neuro surgery
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997839/
https://www.ncbi.nlm.nih.gov/pubmed/33511509
http://dx.doi.org/10.1007/s11060-021-03697-8
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