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Pediatric patients with malignant brain tumor treated at children's hospitals: association with fewer unplanned
Kristie Q Liu1, Shivani D Rangwala1, Talia A Wenger1
11Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles; and.
Insights
Treatment at children's hospitals significantly reduces 30-day readmission rates for pediatric brain tumor patients. This study highlights the benefit of specialized pediatric care for improving outcomes in childhood cancer survivors.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Neurosurgery
Background:
- Pediatric primary brain tumors are a leading cause of childhood cancer mortality.
- Specialized multidisciplinary care is recommended for optimal outcomes in pediatric cancer patients.
- Hospital readmission rates are a key metric for assessing patient outcomes and healthcare quality.
Purpose of the Study:
- To investigate the impact of treatment at a designated children's hospital versus a non-children's hospital on readmission rates for pediatric patients undergoing craniotomy for brain tumor resection.
- To analyze national database records to evaluate the association between hospital designation and patient outcomes.
Main Methods:
- Retrospective analysis of the Nationwide Readmissions Database (2010-2018).
- Inclusion of 4003 patients who underwent craniotomy for brain tumor resection.
- Univariate and multivariate regression analyses to assess the association with 30-day readmissions, mortality, and length of stay.
Main Results:
- Patients treated at children's hospitals (31.4% of cases) had a significantly lower likelihood of 30-day readmission (OR 0.68, p = 0.036).
- No significant difference in index mortality was observed between children's and non-children's hospitals.
- The study provides national estimates on the impact of hospital designation on outcomes.
Conclusions:
- Treatment at children's hospitals is associated with decreased 30-day readmission rates for pediatric brain tumor patients.
- No difference in mortality suggests that specialized care may improve recovery and reduce complications.
- Further prospective studies are recommended to confirm these findings and identify specific factors contributing to better outcomes.
Objective:
Pediatric primary brain tumors are the leading cause of death among childhood cancers. Guidelines recommend specialized care with a multidisciplinary team and focused treatment protocols to optimize outcomes in this patient population. Furthermore, readmission is a key metric of patient outcomes and has been used to inform reimbursement. However, no prior study has analyzed national database-level records to evaluate the role of care in a designated children's hospital following pediatric tumor resection and its impact on readmission rates. The goal of this study was to investigate whether treatment at a children's hospital rather than a nonchildren's hospital has a significant effect on outcome.
Methods:
The Nationwide Readmissions Database records from 2010 to 2018 were analyzed retrospectively to evaluate the effect of hospital designation on patient outcomes after craniotomy for brain tumor resection, and results are reported as national estimates. Univariate and multivariate regression analyses of patient and hospital characteristics were conducted to evaluate if craniotomy for tumor resection at a designated children's hospital was independently associated with 30-day readmissions, mortality rate, and length of stay.
Results:
A total of 4003 patients who underwent craniotomy for tumor resection were identified using the Nationwide Readmissions Database, with 1258 of these cases (31.4%) treated at children's hospitals. Patients treated at children's hospitals were associated with decreased likelihood of 30-day hospital readmission (OR 0.68, 95% CI 0.48-0.97, p = 0.036) compared to patients treated at nonchildren's hospitals. There was no significant difference in index mortality between patients treated at children's hospitals and those treated at nonchildren's hospitals.
Conclusions:
The authors found that patients undergoing craniotomy for tumor resection at children's hospitals were associated with decreased rates of 30-day readmission, with no significant difference in index mortality. Future prospective studies may be warranted to confirm this association and identify components contributing to improved outcomes in care at children's hospitals.
