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International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study

PURPOSE: Although standard-of-care has been defined for the treatment of glioblastoma patients, substantial practice variation exists in the day-to-day clinical management. This study aims to compare the use of laboratory tests in the perioperative care of glioblastoma patients between two tertiary...

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Autores principales: Senders, Joeky T., Maas, Sybren L. N., Draaisma, Kaspar, McNulty, John J., Ashby, Joanna L., Hofer, Imo, van Solinge, Wouter W., Berg, Maarten ten, Snijders, Tom J., Seute, Tatjana, Robe, Pierre A., Gormley, William B., Smith, Timothy R., Broekman, Marike L. D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8854260/
https://www.ncbi.nlm.nih.gov/pubmed/34997355
http://dx.doi.org/10.1007/s00701-021-05090-w
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author Senders, Joeky T.
Maas, Sybren L. N.
Draaisma, Kaspar
McNulty, John J.
Ashby, Joanna L.
Hofer, Imo
van Solinge, Wouter W.
Berg, Maarten ten
Snijders, Tom J.
Seute, Tatjana
Robe, Pierre A.
Gormley, William B.
Smith, Timothy R.
Broekman, Marike L. D.
author_facet Senders, Joeky T.
Maas, Sybren L. N.
Draaisma, Kaspar
McNulty, John J.
Ashby, Joanna L.
Hofer, Imo
van Solinge, Wouter W.
Berg, Maarten ten
Snijders, Tom J.
Seute, Tatjana
Robe, Pierre A.
Gormley, William B.
Smith, Timothy R.
Broekman, Marike L. D.
author_sort Senders, Joeky T.
collection PubMed
description PURPOSE: Although standard-of-care has been defined for the treatment of glioblastoma patients, substantial practice variation exists in the day-to-day clinical management. This study aims to compare the use of laboratory tests in the perioperative care of glioblastoma patients between two tertiary academic centers—Brigham and Women’s Hospital (BWH), Boston, USA, and University Medical Center Utrecht (UMCU), Utrecht, the Netherlands. METHODS: All glioblastoma patients treated according to standard-of-care between 2005 and 2013 were included. We compared the number of blood drawings and laboratory tests performed during the 70-day perioperative period using a Poisson regression model, as well as the estimated laboratory costs per patient. Additionally, we compared the likelihood of an abnormal test result using a generalized linear mixed effects model. RESULTS: After correction for age, sex, IDH1 status, postoperative KPS score, length of stay, and survival status, the number of blood drawings and laboratory tests during the perioperative period were 3.7-fold (p < 0.001) and 4.7-fold (p < 0.001) higher, respectively, in BWH compared to UMCU patients. The estimated median laboratory costs per patient were 82 euros in UMCU and 256 euros in BWH. Furthermore, the likelihood of an abnormal test result was lower in BWH (odds ratio [OR] 0.75, p < 0.001), except when the prior test result was abnormal as well (OR 2.09, p < 0.001). CONCLUSIONS: Our results suggest a substantially lower clinical threshold for ordering laboratory tests in BWH compared to UMCU. Further investigating the clinical consequences of laboratory testing could identify over and underuse, decrease healthcare costs, and reduce unnecessary discomfort that patients are exposed to. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-021-05090-w.
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spelling pubmed-88542602022-02-23 International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study Senders, Joeky T. Maas, Sybren L. N. Draaisma, Kaspar McNulty, John J. Ashby, Joanna L. Hofer, Imo van Solinge, Wouter W. Berg, Maarten ten Snijders, Tom J. Seute, Tatjana Robe, Pierre A. Gormley, William B. Smith, Timothy R. Broekman, Marike L. D. Acta Neurochir (Wien) Original Article - Tumor - Glioma PURPOSE: Although standard-of-care has been defined for the treatment of glioblastoma patients, substantial practice variation exists in the day-to-day clinical management. This study aims to compare the use of laboratory tests in the perioperative care of glioblastoma patients between two tertiary academic centers—Brigham and Women’s Hospital (BWH), Boston, USA, and University Medical Center Utrecht (UMCU), Utrecht, the Netherlands. METHODS: All glioblastoma patients treated according to standard-of-care between 2005 and 2013 were included. We compared the number of blood drawings and laboratory tests performed during the 70-day perioperative period using a Poisson regression model, as well as the estimated laboratory costs per patient. Additionally, we compared the likelihood of an abnormal test result using a generalized linear mixed effects model. RESULTS: After correction for age, sex, IDH1 status, postoperative KPS score, length of stay, and survival status, the number of blood drawings and laboratory tests during the perioperative period were 3.7-fold (p < 0.001) and 4.7-fold (p < 0.001) higher, respectively, in BWH compared to UMCU patients. The estimated median laboratory costs per patient were 82 euros in UMCU and 256 euros in BWH. Furthermore, the likelihood of an abnormal test result was lower in BWH (odds ratio [OR] 0.75, p < 0.001), except when the prior test result was abnormal as well (OR 2.09, p < 0.001). CONCLUSIONS: Our results suggest a substantially lower clinical threshold for ordering laboratory tests in BWH compared to UMCU. Further investigating the clinical consequences of laboratory testing could identify over and underuse, decrease healthcare costs, and reduce unnecessary discomfort that patients are exposed to. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-021-05090-w. Springer Vienna 2022-01-07 2022 /pmc/articles/PMC8854260/ /pubmed/34997355 http://dx.doi.org/10.1007/s00701-021-05090-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/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/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article - Tumor - Glioma
Senders, Joeky T.
Maas, Sybren L. N.
Draaisma, Kaspar
McNulty, John J.
Ashby, Joanna L.
Hofer, Imo
van Solinge, Wouter W.
Berg, Maarten ten
Snijders, Tom J.
Seute, Tatjana
Robe, Pierre A.
Gormley, William B.
Smith, Timothy R.
Broekman, Marike L. D.
International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
title International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
title_full International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
title_fullStr International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
title_full_unstemmed International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
title_short International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
title_sort international practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study
topic Original Article - Tumor - Glioma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8854260/
https://www.ncbi.nlm.nih.gov/pubmed/34997355
http://dx.doi.org/10.1007/s00701-021-05090-w
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