Hospitalization outcomes among brain metastasis patients receiving radiation therapy with or without stereotactic radiosurgery from the 2005–2014 Nationwide Inpatient Sample

Abstract

The purpose of this study was to compare hospitalization outcomes among US inpatients with brain metastases who received stereotactic radiosurgery (SRS) and/or non-SRS radiation therapies without neurosurgical intervention. A cross-sectional study was conducted whereby existing data on 35,199 hospitalization records (non-SRS alone: 32,981; SRS alone: 1035; SRS + non-SRS: 1183) from 2005 to 2014 Nationwide Inpatient Sample were analyzed. Targeted maximum likelihood estimation and Super Learner algorithms were applied to estimate average treatment effects (ATE), marginal odds ratios (MOR) and causal risk ratio (CRR) for three distinct types of radiation therapy in relation to hospitalization outcomes, including length of stay (‘ ≥ 7 days’ vs. ‘ < 7 days’) and discharge destination (‘non-routine’ vs. ‘routine’), controlling for patient and hospital characteristics. Recipients of SRS alone (ATE = − 0.071, CRR = 0.88, MOR = 0.75) or SRS + non-SRS (ATE = − 0.17, CRR = 0.70, MOR = 0.50) had shorter hospitalizations as compared to recipients of non-SRS alone. Recipients of SRS alone (ATE = − 0.13, CRR = 0.78, MOR = 0.59) or SRS + non-SRS (ATE = − 0.17, CRR = 0.72, MOR = 0.51) had reduced risks of non-routine discharge as compared to recipients of non-SRS alone. Similar analyses suggested recipients of SRS alone had shorter hospitalizations and similar risk of non-routine discharge when compared to recipients of SRS + non-SRS radiation therapies. SRS alone or in combination with non-SRS therapies may reduce the risks of prolonged hospitalization and non-routine discharge among hospitalized US patients with brain metastases who underwent radiation therapy without neurosurgical intervention.

Perioperative hemodynamic monitoring in cardiac surgery

“…This may be due to the fact that previous study has suggested that more selective use of PACs may translate to improved outcomes by targeting high-risk patients (i.e., CHF, pulmonary artery hypertension [PAH]) or high-risk procedures (i.e., multiple valve operations, durable left ventricular assist device [LVAD] implantation) [7,8,9 ▪▪ ]. Interestingly, a recently published study of the National Inpatient Sample, which analyzed the outcomes associated with a subgroup of more than 320 000 cardiac surgical records of patients with CHF, PAH, mitral/tricuspid disease or combined surgeries, found that after risk adjustment, although patients with PACs experienced slightly shorter LOS, in-hospital deaths were similar regardless of PAC use [10 ▪▪ ]. PAC use varied as much by the institution as the patient or surgery subgroup, further illustrating the degree to which PAC use is influenced as much by local resources and culture as it is by clinical indication.…”