A national analysis of 9655 pediatric cerebrovascular malformations: effect of hospital volume on outcomes

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OBJECTIVE

Comprehensive multicenter data on the surgical treatment of pediatric cerebrovascular malformations (CVMs) in the US are lacking. The goal of this study was to identify national trends in patient demographics and assess the effect of hospital case volume on outcomes.

METHODS

Admissions for CVMs (1997–2012) were identified from the nationwide Kids’ Inpatient Database. Admissions with and without craniotomy were reviewed separately. Patients were categorized by whether they were treated at low-, medium-, or high-volume centers (< 10, 10–40, > 40 cases/year, respectively). A generalized linear model was used to evaluate the association of hospital pediatric CVM case volume and clinical variables assessing outcomes.

RESULTS

Among the 9655 patients, 1828 underwent craniotomy and 7827 did not. Patient age and race differed in the two groups, as did the rate of private medical payers. High-volume hospitals had fewer nonroutine discharges (11.2% [high] vs 16.4% [medium] vs 22.3% [low], p = 0.0001). For admissions requiring craniotomy, total charges ($106,282 [high] vs $126,215 [medium] vs $134,978 [low], p < 0.001) and complication rates (0.09% [high] vs 0.11% [medium] vs 0.16% [low], p = 0.001) were lower in high-volume centers.

CONCLUSIONS

This study revealed that further investigation may be needed regarding barriers to surgical treatment of pediatric CVMs. The authors found that surgical treatment of pediatric CVM at high-volume centers is associated with significantly fewer complications, better dispositions, and lower costs, but for noncraniotomy patients, low-volume centers had lower rates of complications and death and lower costs. These findings may support the consideration of appropriate referral of CVM patients requiring surgery or with intracranial hemorrhage toward high-volume, specialized centers.

ABBREVIATIONS AVM = arteriovenous malformation; CVM = cerebrovascular malformation; HCUP = Healthcare Cost and Utilization Project; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; ICH = intracranial hemorrhage; KID = Kids’ Inpatient Database.
Article Information

Contributor Notes

Correspondence Vijay M. Ravindra: Clinical Neurosciences Center, University of Utah, Salt Lake City, UT. neuropub@hsc.utah.edu.INCLUDE WHEN CITING Published online August 2, 2019; DOI: 10.3171/2019.5.PEDS19155.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Alawi AEdgell RCElbabaa SKCallison RCKhalili YAAllam H: Treatment of cerebral aneurysms in children: analysis of the Kids’ Inpatient Database. J Neurosurg Pediatr 14:23302014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Barker FG II: Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000: decreasing mortality and the effect of provider caseload. Cancer 100:99910072004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Barker FG IIAmin-Hanjani SButler WEOgilvy CSCarter BS: In-hospital mortality and morbidity after surgical treatment of unruptured intracranial aneurysms in the United States, 1996–2000: the effect of hospital and surgeon volume. Neurosurgery 52:99510092003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Barker FG IIKlibanski ASwearingen B: Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 88:470947192003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Berman MFStapf CSciacca RRYoung WL: Use of ICD-9 coding for estimating the occurrence of cerebrovascular malformations. AJNR Am J Neuroradiol 23:7007052002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Beslow LALicht DJSmith SEStorm PBHeuer GGZimmerman RA: Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study. Stroke 41:3133182010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Brown RD JrWiebers DOTorner JCO’Fallon WM: Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992. Neurology 46:9499521996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Burns EMRigby EMamidanna RBottle AAylin PZiprin P: Systematic review of discharge coding accuracy. J Public Health (Oxf) 34:1381482012

  • 9

    Curry WTMcDermott MWCarter BSBarker FG II: Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102:9779862005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Dasenbrock HHCote DJPompeu YVasudeva VSSmith TRGormley WB: Validation of an International Classification of Disease, Ninth Revision coding algorithm to identify decompressive craniectomy for stroke. BMC Neurol 17:1212017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Gerosa MACappellotto PLicata CIraci GPardatscher KFiore DL: Cerebral arteriovenous malformations in children (56 cases). Childs Brain 8:3563711981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Hoh BLRabinov JDPryor JCCarter BSBarker FG II: In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996–2000: effect of hospital and physician volume. AJNR Am J Neuroradiol 24:140914202003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Holland CMMazur MDBisson EFSchmidt MHDailey AT: Trends in patient care for traumatic spinal injuries in the United States: a National Inpatient Sample study of the correlations with patient outcomes from 2001 to 2012. Spine (Phila Pa 1976) 42:192319292017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Jellinger K: Vascular malformations of the central nervous system: a morphological overview. Neurosurg Rev 9:1772161986

  • 15

    LaPar DJKron ILJones DRStukenborg GJKozower BD: Hospital procedure volume should not be used as a measure of surgical quality. Ann Surg 256:6066152012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    McCormick W: Pathology of vascular malformations of the brain in Wilson CStein B (eds): Intracranial Arteriovenous Malformations. Baltimore: Williams & Wilkins1984 pp 4463

    • Search Google Scholar
    • Export Citation
  • 17

    Michelsen WJ: Natural history and pathophysiology of arteriovenous malformations. Clin Neurosurg 26:3073131979

  • 18

    Riordan CPOrbach DBSmith ERScott RM: Acute fatal hemorrhage from previously undiagnosed cerebral arteriovenous malformations in children: a single-center experience. J Neurosurg Pediatr 22:2442502018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Smith ERButler WEBarker FG II: Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 54:5535652004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Stone MLLapar DJKane BJRasmussen SKMcGahren EDRodgers BM: The effect of race and gender on pediatric surgical outcomes within the United States. J Pediatr Surg 48:165016562013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Titsworth WLScott RMSmith ER: National analysis of 2454 pediatric moyamoya admissions and the effect of hospital volume on outcomes. Stroke 47:130313112016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    van Walraven CAustin P: Administrative database research has unique characteristics that can risk biased results. J Clin Epidemiol 65:1261312012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Wang HHTejwani RZhang HWiener JSRouth JC: Hospital surgical volume and associated postoperative complications of pediatric urological surgery in the United States. J Urol 194:5065112015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:4214301985

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