Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma. (January 2018)

• Record Type: Journal Article
• Authors: Hauser, Alan; Dutta, Sunil W.; Showalter, Timothy N.; Sheehan, Jason P.; Grover, Surbhi; Trifiletti, Daniel M.
• Is Part Of: Journal of clinical neuroscience. Volume 47(2018)
• Page Start: 103
• Page End: 110
• Publication Date: 2018-01
• Subjects: GBM -- Academic -- Survival -- Postoperative -- Morality -- NCDB; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.10.087
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Survival was evaluated among patients in a large database with glioblastoma (GBM). 84, 839 patients were compared based on facility type and facility volume. Patients treated at high volume centers and academic centers had improved survival. Abstract: Objective: To identify if facility type and/or facility volume impact overall survival (OS) following diagnosis of glioblastoma (GBM). We also sought to compare early post-surgical outcomes based on these factors. Methods: The National Cancer Database was queried for patients with GBM 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 OS following diagnosis and Chi-square tests were used to compare early post-surgical outcomes. Results: 89, 839 patients met inclusion criteria. Factors associated with improved OS on multivariable analysis included younger patient age, female gender, race, lower comorbidity score, higher performance score, smaller tumor size, unifocal tumors, MGMT hypermethylation, fully resected tumors, radiotherapy, and chemotherapy (each p < .001). Also, OS was improved among patients treated at centers averaging at least 30.2 cases per year (HR 0.948, compared to <7.4 cases/year, p < .001), and patients treated at Academic/Research programs had improved survival compared to those treated at Comprehensive Community Cancer programs (HR 1.069, p < .001) and Integrated Network Cancer programs (HR 1.126, p < .001). Similarly, Academic/Research programs and high volume centers demonstrated improved 30- and 90-day morality as well as 30-day readmission rates ( p < .001). Conclusions: This study suggests that patients treated in Academic/Research programs and high patient-volume centers have increased survival and 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.