Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar 19;9(3):e92057.
doi: 10.1371/journal.pone.0092057. eCollection 2014.

The association of unfavorable outcomes with the intensity of neurosurgical care in the United States

Symeon Missios  1 , Kimon Bekelis  2
Affiliations

The association of unfavorable outcomes with the intensity of neurosurgical care in the United States

Symeon Missios et al. PLoS One. .

Abstract

Object: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care (defined as the average annual number of neurosurgical procedures per capita) with mortality, length of stay (LOS), and rate of unfavorable discharge for inpatients after neurosurgical procedures.

Methods: We performed a retrospective cohort study involving the 202,518 patients who underwent cranial neurosurgical procedures from 2005-2010 and were registered in the National Inpatient Sample (NIS) database. Regression techniques were used to investigate the association of the average intensity of neurosurgical care with the average mortality, LOS, and rate of unfavorable discharge.

Results: The inpatient neurosurgical mortality, rate of unfavorable discharge, and average LOS varied significantly among several states. In a multivariate analysis male gender, coverage by Medicaid, and minority racial status were associated with increased mortality, rate of unfavorable discharge, and LOS. The opposite was true for coverage by private insurance, higher income, fewer comorbidities and small hospital size. There was no correlation of the intensity of neurosurgical care with the mortality (Pearson's ρ = -0.18, P = 0.29), rate of unfavorable discharge (Pearson's ρ = 0.08, P = 0.62), and LOS of cranial neurosurgical procedures (Pearson's ρ = -0.21, P = 0.22).

Conclusions: We observed significant disparities in mortality, LOS, and rate of unfavorable discharge for cranial neurosurgical procedures in the United States. Increased intensity of neurosurgical care was not associated with improved outcomes.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cohort selection for the study.
Figure 2
Figure 2. Multivariate analysis demonstrating the association of the exposure variables with the average annual mortality for cranial neurosurgical procedures.
The corresponding forest plot is presented on the right.
Figure 3
Figure 3. Scatter plot demonstrating the correlation of the average intensity of neurosurgical care with (A) the average annual mortality (Pearson's ρ = −0.18, P = 0.29), (B) the average annual rate of unfavorable discharge (Pearson's ρ = 0.08, P = 0.62), and (C) the average length of stay for cranial neurosurgical procedures (Pearson's ρ = −0.21, P = 0.22).
Figure 4
Figure 4. Multivariate analysis demonstrating the association of the exposure variables with the average annual rate of unfavorable discharge for cranial neurosurgical procedures.
The corresponding forest plot is presented on the right.
Figure 5
Figure 5. Multivariate analysis demonstrating the association of the exposure variables with the average length of stay for cranial neurosurgical procedures rate.
The corresponding forest plot is presented on the right.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Fisher ES, McClellan MB, Safran DG (2011) Building the path to accountable care. N Engl J Med 365: 2445–2447. - PubMed
    1. Fisher ES, Shortell SM (2010) Accountable care organizations: accountable for what, to whom, and how. JAMA 304: 17115–11716. - PubMed
    1. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, et al. (2003) The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med 138: 288–298. - PubMed
    1. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, et al. (2003) The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med 138: 273–287. - PubMed
    1. Fisher ES, Wennberg JE (2003) Health care quality, geographic variations, and the challenge of supply-sensitive care. Perspect Biol Med 46: 69–79. - PubMed

Grants and funding

The authors have no support or funding to report.

LinkOut - more resources