Impact of facility type and volume on post-surgical outcomes following diagnosis of WHO grade II glioma

Abstract

ObjectiveLow grade gliomas present unique and challenging scenarios. We aimed to identify if facility type and/or facility volume impact overall survival (OS) following diagnosis of WHO grade II gliomas. We also sought to compare early post-surgical outcomes based on these factors. MethodsThe National Cancer Database was queried for patients with WHO grade II gliomas diagnosed from 2004 to 2013 with known survival. Patients were grouped based on facility type and facility volume. Multivariable analyses were performed to investigate factors associated with OS following diagnosis, and Chi-square tests were used to compare early post-surgical outcomes. Results6428 patients met inclusion criteria. Factors associated with improved OS on multivariable analysis included younger patient age, female gender, race, non-use of radiotherapy (each p < 0.001). Also, on multivariable analysis, OS was improved among patients treated at Academic/Research programs compared to those treated at Non-Academic/Research programs (HR 0.898, p = 0.014), but facility volume did not impact OS (p = 0.760). Thirty-day mortality did not differ by facility type (p = 0.265), but 90-day morality as well as 30-day readmission rates were more favorable in Academic/Research programs (p = 0.008 and <0.001, respectively). ConclusionsThis study suggests that patients treated in Academic/Research programs have increased survival and generally more favorable early-postsurgical outcomes. The extent to which differences in patient populations, socioeconomic factors, and/or provider expertise play into this cause will be areas of future research.