Quality indicators in cranial neurosurgery: current insights and critical evaluation - a systematic review

In recent decades, there has been increasing interest in measuring the quality of care across all medical fields, including neurosurgery. This interest aims not only to optimize care but also to reduce healthcare costs. For this purpose, different quality indicators (QIs) have been developed. We performed a systematic review according to the PRISMA guidelines aiming at identifying studies that critically evaluate QIs applied in cranial neurosurgery. A total of 34 studies, suggesting 22 indicators, were identified. The most discussed indicator was the 30-day readmission rate, followed by the 30-day reoperation rate. The majority of QIs are influenced by baseline and underlying patient characteristics, reflecting the severity of the patient`s underlying disease, rather than adherence to best available evidence of treatment. Therefore, it is crucial to implement adequate risk adjustment strategies when applying QIs to compensate for differences in patient complexity and to ensure that departments that are treating high-risk patients do not have worse results. The review revealed several limitations of the currently used quality indicators. Most suggested indicators are attractive from a payer point of view, easy to measure and therefore convenient for reimbursement purposes. However, from a clinician's point of view, most indicators were considered poor performance markers as they do not correlate with meaningful outcome and do not reflect treatment quality. In addition, there is a lack of disease- and neurosurgery specific indicators. This highlights the need for clinicians to actively participate in developing more clinically relevant QIs tailored to neurosurgical practice.