Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Abstract

Study design: Retrospective cohort study. Objective: Data on patient outcomes after surgery for spinal cord tumors have been derived from single-institution series. The objective of this study is to report inpatient complications, mortality and outcomes on a national level. Setting: United States, national inpatient care database. Methods: The National Inpatient Sample (NIS) was used to identify 19 017 admissions for resection of a spinal cord tumor in the United States from 1993 to 2002. The effects of patient and hospital characteristics on inpatient outcomes were analyzed using logistic regression. Results: The in-hospital mortality rate and the complication rate were 0.55 and 17.5%, respectively. Urinary and renal complications (3.7%), postoperative hemorrhages or hematomas (2.5%) and pulmonary complications (2.4%) were the most common complications reported. A single postoperative complication increased the length of stay by 4 days, increased the mortality rate by sixfold and added over $10 000 to hospital charges. Multivariate analysis showed that complications were more likely in African Americans and patients with multiple comorbidities. The odds of an adverse outcome increased significantly with age greater than 64, multiple comorbidities and postoperative complications. Conclusion: A national perspective on inpatient outcomes after resection of spinal cord tumors has been provided. The significant negative impact of postoperative complications on mortality and resource utilization has been demonstrated. We have identified advanced age and multiple comorbidities as risk factors that predict adverse outcome. Furthermore, this study highlights the importance of avoidance, recognition and prompt management of nonneurologic complications.

Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010

“…16 Similarly, compared with the results of an earlier study of surgically treated SCTs in the US between 1993 and 2002, the total complication rate and mean length of stay decreased from 17.5% and 7.2 days, respectively, in 1993-2002 to 4.2% and 6.39 days in 2002-2010. The number of patients has remained the same during the study period despite an increase in the number of reporting hospitals, which is in accordance with the previous study.…”

“…In a previous study, Patil et al 16 reported the incidence of complications and outcomes following SCT surgery between 1993 and 2002; however, there is no study focusing on the demographic and hospital-related factors that can affect the discharge disposition and cost of hospitalization.…”

“…To the best of our knowledge there has been only one study in which the complications and outcomes following SCT resection were analyzed using the data compiled in the NIS database from 1993 to 2002. 16 In that study, the adverse outcome following SCT resection was found to be associated with a higher comorbidity index and occurrence of postoperative complications. However, there is no study that has analyzed all the variables such as the hospital affiliation, complications, comorbidities, and hospital charges following resection of IMSCTs.…”

“…Similarly, Patil et al 16 reported fewer adverse discharge dispositions in young patients with a low comorbidity index and without complications; however, there was no difference in the outcome between the sexes. Our analysis showed that the following variables-young patients, those with nonprivate insurance, median household income in the 4th quartile, and high comorbidity index-were the independent predictors of in-hospital mortality (p < 0.001).…”

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

“…Patients with private insurance are assumed to have better primary care access, which contributes to better maintenance of medical conditions. To this effect, our data show that patients with private insurance had a lower 57 found that age greater than 64 years had an increasingly significant association with postoperative adverse outcome. Sharma et al 61 also observed a higher likelihood of an adverse event in middle-aged and elderly patients after SCT surgery.…”