Volume effect in paediatric brain tumour resection surgery: analysis of data from the Japanese national inpatient database. (March 2019)

• Record Type: Journal Article
• Authors: Shinjo, Daisuke; Matsumoto, Kimikazu; Terashima, Keita; Takimoto, Tetsuya; Ohnuma, Tetsu; Noguchi, Takashi; Fushimi, Kiyohide
• Is Part Of: European journal of cancer. Volume 109(2019)
• Page Start: 111
• Page End: 119
• Publication Date: 2019-03
• Subjects: Paediatric -- Brain tumour -- Resection surgery -- Administrative database -- DPC -- Japan; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2018.12.030
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Paediatric brain tumours are the second most common type of malignancies that occur during childhood. Surgical resection is usually the first step in the treatment of these patients; however, evidence pertaining to a 'volume effect' in paediatric brain tumour resection surgery and the associations among the surgical volume, clinical features and treatments are not well characterised. Methods: Data pertaining to paediatric patients (age ≤ 15 years) who underwent brain tumour resection surgery between April 2012 and March 2016 were retrieved from the Japanese administrative inpatient database and retrospectively analysed. Demographic characteristics, therapeutic procedures and in-hospital mortality were summarised according to the hospital surgical volume. Penalised logistic regression analysis was used to investigate the association between the hospital surgical volume and in-hospital mortality. Results: A total of 1354 paediatric patients were included. About 40% of the patients were in the 11- to 15-year age group. The male:female ratio was 53:47, the overall crude in-hospital mortality was 1.8% (n = 24) and the 30-day postoperative mortality was 0.4% (n = 6). The crude mortality ratio was 3.3% in the lowest quartile and 0.8% in the highest quartile by volume. After adjusting for covariates, a higher hospital surgical volume was associated with lower in-hospital mortality (compared with 1–4 surgeries per 4 years, 15–25 surgeries, odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.05–0.90, p = 0.033; ≥26 surgeries, OR: 0.31; 95% CI: 0.08–0.96, p = 0.042). Conclusions: The present study indicated a volume–outcome relationship in paediatric brain tumour resection surgery cases. Further centralisation of surgeries should be considered to achieve better outcomes. Highlights: Volume effect in paediatric brain tumour resection surgery is inconsistent. National inpatient database and penalised likelihood model were used. The crude in-hospital mortality ratio was 1.8%, comparable to other countries. The study indicated a volume effect in paediatric brain tumour resection surgery.