Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers

OBJECTIVE: Improved clinical and economic outcomes for high-risk surgical procedures have been previously cited in support of regionalization. The goal of this study was to examine the effects of regionalization by analyzing the cost and outcome of craniotomy for tumors and to compare the findings in academic medical centers versus community-based hospitals. METHODS: Outcomes and charges were analyzed for all adult patients undergoing craniotomy for tumor in 33 nonfederal acute care hospitals in Maryland using the Maryland Health Service Cost Review Commission database for the years 1990 to 1996. A total of 4723 patients who underwent craniotomy for tumor were selected on the basis of Diagnostic Related Group 1 (craniotomy except for trauma, age 18 or older) and International Classification of Diseases-9th Revision diagnosis code for benign tumor, primary malignant neoplasm, or secondary malignant neoplasm (codes 191, 192, 194, 200, 225, 227, 228, 237, and 239). Hospitals were categorized as high-volume hospitals (<50 craniotomies/yr) or low-volume hospitals (≥50 craniotomies/yr). In-hospital mortality, length of stay, and charges were evaluated. RESULTS: The mortality rate was 2.5% at high-volume centers and 4.9% at low-volume hospitals with an adjusted relative risk of 1.4 (P < 0.05), assuming equivalence of disease severity. Adjusted average length of stay in high-volume centers was 6.8, as compared with 8.8 days in low-volume hospitals (P < 0.001). Adjusted average total charges were $15,867 at high-volume centers and $14,045 at low-volume centers (P < 0.001). If all patients in the state had been treated at centers with survival rates equal to those achieved by the high-volume centers, then 46 patients would not have died of operation; that is, 48.6% fewer patients would have died, at an additional adjusted cost of $76,395 dollars per patient saved. CONCLUSION: High-volume regional medical centers are capable of providing services with improved mortality rates and fewer hospital days, although with adjusted costs slightly higher than those at low-volume hospitals.