High-Volume Centers Provide Superior Value of Care in the Surgical Treatment of Malignant Brain Tumor

Abstract

Improved outcomes in surgical patients have been associated with increasing volume of cases. This has led to the development of centers that facilitate care for a specific patient population. To evaluate associations of outcomes with hospital characteristics in patients undergoing resection of malignant brain tumors. The 2016-2020 National Inpatient Sample (NIS) was queried for patients undergoing resection of malignant brain tumors. Teaching hospitals with case loads greater than two standard deviations above the mean (140 cases) were categorized as high-volume centers (HVC). Value of care (VoC) was evaluated by adding one point for each of the following: short length of stay, low total charges, favorable discharge disposition, and lack of major comorbidity or complication. A total of 118,390 patients underwent resection of malignant brain tumors in 3009 hospitals. HVC criteria was met by 91 (3%) hospitals. HVC were more likely to treat patients of younger age or higher socioeconomic status (p < 0.01 for all). The Mid-Atlantic and South Atlantic regions had the highest percentage of cases and number of HVC. VoC was higher at HVC (p < 0.01). HVC was associated with decreased complications (p < 0.01 for all) and improved patient outcomes (p < 0.01 for all). Patients undergoing craniotomy for malignant brain neoplasms have superior outcomes in HVC. Trends of centralization may be a reflection of the benefits of multidisciplinary treatment, geographic preferences, publicity, and cultural impact. Improvement of access to care is an important consideration as this trend continues.