The effect of NACHRI children's hospital designation on outcome in pediatric malignant brain tumors

• Authors: Daniel A. Donoho, University of Southern California; Timothy Wen, University of Southern California; Jonathan Liu, University of Southern California; Hosniya Zarabi, Emory University; Eisha Christian, University of Southern California; Steven Cen, Children's Hospital of Los Angeles; Gabriel Zada, University of Southern California; J. Gordon McComb, Children's Hospital of Los Angeles; Mark D. Krieger, Children's Hospital of Los Angeles; William J. Mack, University of Southern California; Frank J. Attenello, University of Southern California
• Journal Title: JOURNAL OF NEUROSURGERY-PEDIATRICS
• Volume: Volume 20, Number 2
• Publisher: AMER ASSOC NEUROLOGICAL SURGEONS | 2017-08-01, Pages 149-157
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.3171/2017.1.PEDS16527
• Subjects: Biology, Neuroscience; Health Sciences, Medicine and Surgery; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Pediatrics; Surgery; Neurosciences & Neurology; malignant pediatric brain tumor; hospital designation; outcomes; oncology; RESOURCE UTILIZATION; OPERATIVE MORTALITY; CLINICAL-OUTCOMES; ONCOLOGY GROUP; UNITED-STATES; VOLUME; SPECIALTY; SURVIVAL; IMPACT; SURGERY

Abstract

Objective: Although current pediatric neurosurgery guidelines encourage the treatment of pediatric malignant brain tumors at specialized centers such as pediatric hospitals, there are limited data in support of this recommendation. Previous studies suggest that children treated by higher-volume surgeons and higher-volume hospitals may have better outcomes, but the effect of treatment at dedicated children's hospitals has not been investigated. Methods: The authors analyzed the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) from 2000-2009 and included all patients undergoing a craniotomy for malignant pediatric brain tumors based on ICD-9-CM codes. They investigated the effects of patient demographics, tumor location, admission type, and hospital factors on rates of routine discharge and mortality. Results: From 2000 through 2009, 83.6% of patients had routine discharges, and the in-hospital mortality rate was 1.3%. In multivariate analysis, compared with children treated at an institution designated as a pediatric hospital by NACHRI (National Association of Children's Hospitals and Related Institutions), children receiving treatment at a pediatric unit within an adult hospital (OR 0.5, p < 0.01) or a general hospital without a designated pediatric unit (OR 0.4, p < 0.01) were less likely to have routine discharges. Treatment at a large hospital (> 400 beds; OR 1.8, p = 0.02) and treatment at a teaching hospital (OR 1.7, p = 0.02) were independently associated with greater likelihood of routine discharge. However, patients transferred between facilities had a significantly decreased likelihood of routine discharge (OR 0.5, p < 0.01) and an increased likelihood of mortality (OR 5.0, p < 0.01). Procedural volume was not associated with rate of routine discharge or mortality. Conclusions: These findings may have implications for planning systems of care for pediatric patients with malignant brain tumors. The authors hope to motivate future research into the specific factors that may lead to improved outcomes at designated pediatric hospitals.