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  • The Effect of Hospital Case-Volume on Pediatric Patients with Resected Posterior Fossa Tumors

    Final Number:

    Annie Isabelle Drapeau MD; David M. Kline PhD; Adrienne Boczar MPH; Julie C. Leonard MD MPH; Jeffrey R. Leonard MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Higher volume hospitals correlate with improved markers of quality of care in various surgical specialties. The purpose of this study was to investigate the effect of volume on the outcomes of children undergoing posterior fossa tumor resection.

    Methods: We queried the Pediatric Health Information System (PHIS) for children ages 0-17 years undergoing posterior fossa tumor resection between 2011 and 2015. Length of hospital stay (LOS), routine discharge home, and adjusted total cost were analyzed for associations with hospital volume (low, medium and high categories, or continuous variable) adjusted for patient demographic and clinical characteristics. LOS was defined as time to routine discharge with patients not routinely discharged censored at time of disposition.

    Results: A mean of 2,893 children per year underwent surgery in 49 U.S. hospitals. The hazard of routine discharge in high volume hospitals was 27% higher than medium (p=0.0010) and 28% higher than low (p=0.0003), reflecting shorter LOS in high volume centers. As a binary endpoint, the odds ratios for routine discharge were 1.50 (p=0.2417), 2.07 (p=0.0303), and 1.38 (p=0.2417) for high vs. medium, high vs. low, and medium vs. low volume hospitals, respectively. The geometric mean costs in high volume hospitals were 59% and 37% less than in medium (p=0.0158) and low volume hospitals (p=0.1858), respectively. An increase in average annual volume of 50 patients (continuous covariate analysis) increased the hazard of routine discharge by 13% (p=0.0002), increased the odds of routine discharge by 32% (p=0.0892), and reduced the geometric mean cost by 27% (p=0.0767).

    Conclusions: Higher volume hospitals in PHIS had improved quality of care (shorter hospital LOS, increased discharge home, and reduced costs) for children requiring posterior fossa tumor resection. Referral to higher volume children's hospitals may improve outcomes for children with newly diagnosed posterior fossa tumors.

    Patient Care: Identifying markers of quality of care could contribute to improving the outcomes of pediatric patients undergoing complex surgical interventions such as posterior fossa tumor resections. Showing an association between hospital case volumes and these markers of quality of care could influence health care policy makers and referral patterns to surgical subspecialties.

    Learning Objectives: 1) Understand the utility of large prospectively collected nationwide databases. 2) Discuss the markers of quality of care in pediatric neurosurgery. 3) Modify referral patterns to surgical subspecialties.


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