Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery
Year: 2019
Type: article
Study design: Observational Study
Abstract: PURPOSE: Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. METHODS: Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. RESULTS: Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34-3.26, P = 0.001), and not with academic setting, nor with case volume. CONCLUSIONS: Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.
Source: Journal of Neuro-Oncology
Authors: on behalf of the Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery, Philip C. De Witt Hamer, Vincent K. Y. Ho, Aeilko H. Zwinderman, Linda Ackermans, Hilko Ardon, Sytske Boomstra, Wim Bouwknegt, Wimar A. van den Brink, Clemens M. Dirven, Niels A. van der Gaag, Olivier van der Veer, Albert J. S. Idema, Alfred Kloet, Jan Koopmans, Mark ter Laan, Marco J. T. Verstegen, Michiel Wagemakers, Pierre A. J. T. Robe
Institutions: Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands Comprehensive Cancer Organisation, Amsterdam University Medical Centers, Amsterdam UMC Location University of Amsterdam, Maastricht University Medical Centre, Elisabeth-TweeSteden Ziekenhuis, Medisch Spectrum Twente, Slotervaartziekenhuis, Isala, Erasmus MC, Haga Hospital, Leiden University Medical Center, Noordwest Ziekenhuisgroep, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, Martini Ziekenhuis, Radboud University Medical Center, University Medical Center Groningen, University of Groningen, University Medical Center Utrecht
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,760
OpenAlex ID: W2953524596