Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery

on behalf of the Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods: Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results: Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34–3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions: Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.
Original languageEnglish
JournalJournal of Neuro-Oncology
DOIs
Publication statusPublished - 2019

Cite this

on behalf of the Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery. / Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery. In: Journal of Neuro-Oncology. 2019.
@article{f6bb338ec3c749fab274fd4077a46104,
title = "Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery",
abstract = "Purpose: Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods: Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results: Overall 30-day mortality was 5.2{\%} and overall 2-year survival was 13.5{\%}. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73{\%}. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34–3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions: Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.",
author = "{on behalf of the Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery} and {de Witt Hamer}, {Philip C.} and Ho, {Vincent K. Y.} and Zwinderman, {Aeilko H.} and Linda Ackermans and Hilko Ardon and Sytske Boomstra and Wim Bouwknegt and {van den Brink}, {Wimar A.} and Dirven, {Clemens M.} and {van der Gaag}, {Niels A.} and {van der Veer}, Olivier and Idema, {Albert J. S.} and Alfred Kloet and Jan Koopmans and {ter Laan}, Mark and Verstegen, {Marco J. T.} and Michiel Wagemakers and Robe, {Pierre A. J. T.}",
year = "2019",
doi = "10.1007/s11060-019-03229-5",
language = "English",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Kluwer Academic Publishers",

}

Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery. / on behalf of the Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery.

In: Journal of Neuro-Oncology, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery

AU - on behalf of the Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery

AU - de Witt Hamer, Philip C.

AU - Ho, Vincent K. Y.

AU - Zwinderman, Aeilko H.

AU - Ackermans, Linda

AU - Ardon, Hilko

AU - Boomstra, Sytske

AU - Bouwknegt, Wim

AU - van den Brink, Wimar A.

AU - Dirven, Clemens M.

AU - van der Gaag, Niels A.

AU - van der Veer, Olivier

AU - Idema, Albert J. S.

AU - Kloet, Alfred

AU - Koopmans, Jan

AU - ter Laan, Mark

AU - Verstegen, Marco J. T.

AU - Wagemakers, Michiel

AU - Robe, Pierre A. J. T.

PY - 2019

Y1 - 2019

N2 - Purpose: Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods: Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results: Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34–3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions: Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.

AB - Purpose: Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods: Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results: Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34–3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions: Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85068134263&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31236819

U2 - 10.1007/s11060-019-03229-5

DO - 10.1007/s11060-019-03229-5

M3 - Article

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

ER -