Inpatient and Postdischarge Outcomes Following Elective Craniotomy for Mass Lesions

Fry, Donald E.; Nedza, Susan M.; Pine, Michael; Reband, Agnes M.; Huang, Chun-Jung; Pine, Gregory

doi:10.1093/neuros/nyy396

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Fry et al reported a 90 days readmission rate of 25% after elective craniotomy for a mass lesion. Seizures, sepsis, wound complications, pneumonia, and postoperative infections were the most common causes for readmission [18], while Lau et al, reported a 90 days readmission rate of 13% and 20% after surgery for spinal chordoma and chondrosarcoma, respectively. They also reported that wound infection, tumor recurrence requiring decompression, postoperative pain, and proximal junctional kyphosis requiring revision procedure were the most common causes for readmission [19].…”

Section: Discussionmentioning

confidence: 99%

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

et al. 2020

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Background: The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model "Bundled Payment for Care Improvement (BPCI)" which reimburses providers a predetermined payment in advance to cover all possible services rendered within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assessed the feasibility of the BPCI model in these neurosurgical diseases. Methods: We selected patients with chordoma/chondrosarcoma from inpatient admission table using the International Classification of Disease, 9th (ICD-9), and 10th (ICD-10) revision codes. We collected the patients' demographics and insurance type at the index hospitalization. We recorded the following outcomes length of stay, total payment, discharge disposition, and complications for the index hospitalization. For post-discharge, we collected the 30 days and 3/6/12 months inpatient admission, outpatient service, and medication refills. Continuous variables were summarized by means with standard deviations, median with interquartile and full ranges (minimum-maximum); Continuous outcomes were compared by nonparametric Wilcoxson rank-sum test. All tests were 2-sided with a significance level of 0.05. Statistical data analysis was performed in SAS 9.4 (SAS Institute, Inc, Cary, NC). Results: The population size was 2041 patients which included 1412 patients with cranial (group1), 343 patients with a mobile spine (group 2), and 286 patients with sacrococcygeal (group 3) chordoma and chondrosarcoma. For index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.

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Section: Discussionmentioning

confidence: 99%

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

et al. 2020

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“…The higher readmission rates for the mobile spine and sacral groups could have been due to pain or wound problems when compared to the cranial group. Fry et al reported a 90 days readmission rate of 25% after elective craniotomy for a mass lesion [18], while Lau et al reported a 90 days readmission rate of 13 % and 20% after surgery for spinal chordoma and chondrosarcoma, respectively. The difference between our study and Lau et al, their reported rate could have been due to a smaller sample size (23 chordomas, 10 chondrosarcomas).…”

Section: Discussionmentioning

confidence: 99%

“…reported that seizures, sepsis, wound complications, pneumonia, and postoperative infections were the most common causes for readmission after elective cranial surgery for mass lesion. [18] Lau et al…”

Section: Discussionmentioning

confidence: 99%

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the Feasibility of the Bundled Payment Model

Aljuboori

Ugiliweneza

Wang

et al. 2020

Preprint

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Background Healthcare expenditures are continuously rising in the United States. The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model called the “Bundled Payment for Care Improvement (BPCI)”. This model reimburses providers a predetermined payment in advance to cover all possible services delivered to patients within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assess the BPCI model in complex neurosurgical diseases. Methods We obtained data from the United States MarketScan database. Patients were identified patients using the International Classification of Diseases 10 codes. Results A total of 2041 patients were included. 1412 patients had cranial, 343 patients had a mobile spine, and 286 patients had sacrococcygeal chordoma and chondrosarcoma. For Index hospitalization, the median length of stay (days) was 4, 6, and 7, mean total payments were ($58,130), ($84,854), and ($82,440), and complication rates were 30%, 35%, and 43% for groups 1, 2, and 3, respectively. The payments during the first 6 months after discharge were comparable to the amounts reimbursed during the index hospitalization for all groups. Conclusion The management of craniospinal chordoma and chondrosarcoma is costly and sustained over time. The success of BPCI requires a joint effort between insurers and hospitals. It should consider patients’ comorbidities, the complexity of the disease. Finally, adoption of quality improvement programs by hospitals can help with cost reduction.

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“…1,37 They can be associated with delayed recovery and major postoperative complications; meta-analysis has identified that approximately a quarter of patients may require readmission to hospital after traditional craniotomies due to perioperative complications such as infection, seizures, and cardiovascular-respiratory issues. 38 They may also be associated with long-term psychological and cognitive morbidity after being utilized for meningioma resection, including impaired memory, psychomotor speed, and poor attention. 37,39,40 This stimulated the development of alternative approaches, such EEAs and minimally invasive supraorbital craniotomies, to provide focused yet adequate surgical access to tumors.…”

Section: Surgical Options For Resection Of Tuberculum Sella Meningiom...mentioning

confidence: 99%

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

Ved

Hayhurst

2021

J Neurol Surg B Skull Base

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Objectives Controversy exists surrounding the optimal approaches to tuberculum sella meningioma (TSM) and planum meningioma (PM). Olfaction is infrequently considered within this context but is nonetheless an important quality of life measure. The evolution of olfactory outcomes following contemporary transcranial surgery remains unclear. This study reviews olfactory outcomes after supraorbital craniotomy for TSM or PM and defines temporal trends in its recovery. Study Design A prospective study of a patients who underwent a minimally invasive supraorbital craniotomy for TSM or PM was conducted at a single neurosurgical center. Participants & Main Outcome Measures All patients were questioned about olfaction at presentation 3 months postoperatively, 12 months postoperatively, and annually thereafter (median follow-up = 37 months). The olfactory status of patients was categorized as normosmia, anosmia, hyposmia, parosmia, (altered perception of odours), or phantosmia, (olfactory hallucinations). Results Twenty-two patients were included in the study analysis, (range = 27–76). Precisely, 3 months after surgery, seven patients had normal olfaction (32%). Six patients were anosmic, (27%) four hyposmic, (18%), three parosmic, (14%), and two were phantosmic (9%). At 1-year follow-up, almost half of patients (10; 48%) were normosmic, while two patients (9.5%) were anosmic. There were no further improvements in olfaction between 1 year and long-term follow-up. Conclusion Subfrontal transcranial approaches for TSM or PM appear to be associated with changes in olfaction that can improve with time; these improvements occur within the first year after surgery. Impacts upon olfaction should be considered when selecting a surgical approach and patients counseled appropriately.

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Inpatient and Postdischarge Outcomes Following Elective Craniotomy for Mass Lesions

Abstract: There was a 35% difference between best and suboptimal performing hospitals for this operation. Hospitals must know their risk-adjusted AO rates and benchmark their results to inform processes of care redesign.

Cited by 6 publications

References 29 publications

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the Feasibility of the Bundled Payment Model

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

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