In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care

View More View Less
  • 1 Neurosurgical Service, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. Death after ventriculoperitoneal (VP) shunt surgery is uncommon, and therefore it has been difficult to study. The authors used a population-based national hospital discharge database to examine the relationship between annual hospital and surgeon volume of VP shunt surgery in pediatric patients and in-hospital mortality rates.

Methods. All children in the Nationwide Inpatient Sample (1998–2000, age 90 days—18 years) who underwent VP shunt placement or shunt revision as the principal procedure were included. Main outcome measures were in-hospital mortality rates, length of stay (LOS), and total hospital charges.

Overall, 5955 admissions were analyzed (253 hospitals, 411 surgeons). Mortality rates were lower at high-volume centers and for high-volume surgeons. In terms of hospital volume, the mortality rate was 0.8% at lowest-quartile-volume centers (< 28 admissions/year) and 0.3% at highest-quartile-volume centers (> 121 admissions/year). In terms of surgeon volume, the mortality rate was 0.8% for lowest-quartile-volume providers (< nine admissions/year) and 0.1% for highest-quartile-volume providers (> 65 admissions/year). After multivariate adjustment for demographic variables, emergency admission and presence of infection, hospital volume of care remained a significant predictor of death (odds ratio [OR] for a 10-fold increase in caseload 0.38; 95% confidence interval [CI] 0.18–0.81). Surgeon volume of care was statistically significant in a similar multivariate model (OR for a 10-fold increase in caseload 0.3; 95% CI 0.13–0.69). Length of stay was slightly shorter and total hospital charges were slightly higher at higher-volume centers, but the differences were not statistically significant.

Conclusions. Pediatric shunt procedures performed at high-volume hospitals or by high-volume surgeons were associated with lower in-hospital mortality rates, with no significant difference in LOS or hospital charges.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Fred G. Barker II, M.D., Brain Tumor Center, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114. email: barker@helix.mgh.harvard.edu.
  • 1.

    Albright AL, , Pollack IF, & Adelson PD, et al: Outcome data and analysis in pediatric neurosurgery. Neurosurgery 45:101106, 1999 Albright AL, Pollack IF, Adelson PD, et al: Outcome data and analysis in pediatric neurosurgery. Neurosurgery 45:101–106, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Albright AL, , Sposto R, & Holmes E, et al: Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors. Neurosurgery 47:879887, 2000 Albright AL, Sposto R, Holmes E, et al: Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors. Neurosurgery 47:879–887, 2000

    • Search Google Scholar
    • Export Citation
  • 3.

    Altman DG, , Lausen B, & Sauerbrei W, et al: Dangers of using “optimal” cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst 86:829835, 1994 Altman DG, Lausen B, Sauerbrei W, et al: Dangers of using “optimal” cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst 86:829–835, 1994

    • Search Google Scholar
    • Export Citation
  • 4.

    American Academy of Pediatrics Surgical Advisory Panel: Guidelines for referral to pediatric surgical specialists. Pediatrics 110:187191, 2002 American Academy of Pediatrics Surgical Advisory Panel: Guidelines for referral to pediatric surgical specialists. Pediatrics 110:187–191, 2002

    • Search Google Scholar
    • Export Citation
  • 5.

    Bardach NS, , Zhao S, & Gress DR, et al: Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 33:18511856, 2002 Bardach NS, Zhao S, Gress DR, et al: Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 33:1851–1856, 2002

    • Search Google Scholar
    • Export Citation
  • 6.

    Barker FG II, , Amin-Hanjani S, & Butler WE, et al: 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 52:9951009, 2003 Barker FG II, Amin-Hanjani S, Butler WE, et al: 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 52:995–1009, 2003

    • Search Google Scholar
    • Export Citation
  • 7.

    Begg CB, , Cramer LD, & Hoskins WJ, et al: Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280:17471751, 1998 Begg CB, Cramer LD, Hoskins WJ, et al: Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280:1747–1751, 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    Birkmeyer JD, , Finlayson SR, & Tosteson AN, et al: Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 125:250256, 1999 Birkmeyer JD, Finlayson SR, Tosteson AN, et al: Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 125:250–256, 1999

    • Search Google Scholar
    • Export Citation
  • 9.

    Birkmeyer JD, , Siewers AE, & Finlayson EV, et al: Hospital volume and surgical mortality in the United States. N Engl J Med 346:11281137, 2002 Birkmeyer JD, Siewers AE, Finlayson EV, et al: Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137, 2002

    • Search Google Scholar
    • Export Citation
  • 10.

    Borgbjerg BM, , Gjerris F, & Albeck MJ, et al: Risk of infection after cerebrospinal fluid shunt: an analysis of 884 first-time shunts. Acta Neurochir 136:17, 1995 Borgbjerg BM, Gjerris F, Albeck MJ, et al: Risk of infection after cerebrospinal fluid shunt: an analysis of 884 first-time shunts. Acta Neurochir 136:1–7, 1995

    • Search Google Scholar
    • Export Citation
  • 11.

    Cochrane DD, & Kestle J: Ventricular shunting for hydrocephalus in children: patients, procedures, surgeons and institutions in English Canada, 1989–2001. Eur J Pediatr Surg 12 Suppl 1:S6S11, 2002 Cochrane DD, Kestle J: Ventricular shunting for hydrocephalus in children: patients, procedures, surgeons and institutions in English Canada, 1989–2001. Eur J Pediatr Surg 12 Suppl 1:S6–S11, 2002

    • Search Google Scholar
    • Export Citation
  • 12.

    Cochrane DD, , Kestle J, & Evans D, et al: Does practice make perfect in treating hydrocephalus? J Neurosurg 82:363A, 1995 (Abstract) Cochrane DD, Kestle J, Evans D, et al: Does practice make perfect in treating hydrocephalus? J Neurosurg 82:363A, 1995 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 13.

    Cowan JA Jr, , Dimick JB, & Leveque JC, et al: The impact of provider volume on mortality after intracranial tumor resection. Neurosurgery 52:4854, 2003 Cowan JA Jr, Dimick JB, Leveque JC, et al: The impact of provider volume on mortality after intracranial tumor resection. Neurosurgery 52:48–54, 2003

    • Search Google Scholar
    • Export Citation
  • 14.

    Cronenwett JL, & Birkmeyer JD (eds): The Dartmouth Atlas of Vascular Health Care. Chicago: American Hospital Publishing, 2000 Cronenwett JL, Birkmeyer JD (eds): The Dartmouth Atlas of Vascular Health Care. Chicago: American Hospital Publishing, 2000

    • Search Google Scholar
    • Export Citation
  • 15.

    George R, , Leibrock L, & Epstein M: Long-term analysis of cerebrospinal fluid shunt infections. A 25-year experience. J Neurosurg 51:804811, 1979 George R, Leibrock L, Epstein M: Long-term analysis of cerebrospinal fluid shunt infections. A 25-year experience. J Neurosurg 51:804–811, 1979

    • Search Google Scholar
    • Export Citation
  • 16.

    Hannan EL, , O'Donnell JF, & Kilburn H Jr, et al: Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 262:503510, 1989 Hannan EL, O'Donnell JF, Kilburn H Jr, et al: Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 262:503–510, 1989

    • Search Google Scholar
    • Export Citation
  • 17.

    Hannan EL, , Racz M, & Kavey RE, et al: Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 101:963969, 1998 Hannan EL, Racz M, Kavey RE, et al: Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 101:963–969, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Harrell FE Jr: Hmisc and Design libraries for S-Plus for Windows. Software and electronic documentation. 2000. http://hesweb1.med.virginia.edu/biostat/s/splus.html Harrell FE Jr: Hmisc and Design libraries for S-Plus for Windows. Software and electronic documentation. 2000. http://hesweb1.med.virginia.edu/biostat/s/splus.html

    • Search Google Scholar
    • Export Citation
  • 19.

    Harrell FE Jr: Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York: Springer, 2001 Harrell FE Jr: Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York: Springer, 2001

    • Search Google Scholar
    • Export Citation
  • 20.

    Hewitt M: Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary. Washington, DC: National Academy Press, 2000 Hewitt M: Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary. Washington, DC: National Academy Press, 2000

    • Search Google Scholar
    • Export Citation
  • 21.

    Hillner BE, , Smith TJ, & Desch CE: Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 18:23272340, 2000 Hillner BE, Smith TJ, Desch CE: Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 18:2327–2340, 2000

    • Search Google Scholar
    • Export Citation
  • 22.

    Hosmer DW Jr, & Lemeshow S: Applied Logistic Regression, ed 2. New York: John Wiley & Sons, 2000 Hosmer DW Jr, Lemeshow S: Applied Logistic Regression, ed 2. New York: John Wiley & Sons, 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Jamjoom AB, , Jamjoom ZAB, & Ur-Rahman N, et al: Factors affecting cerebrospinal fluid shunt revision rate in children at King Khalid University Hospital. Saudi Med J 19:1518, 1998 Jamjoom AB, Jamjoom ZAB, Ur-Rahman N, et al: Factors affecting cerebrospinal fluid shunt revision rate in children at King Khalid University Hospital. Saudi Med J 19:15–18, 1998

    • Search Google Scholar
    • Export Citation
  • 24.

    Jenkins KJ, , Newburger JW, & Lock JE, et al: In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95:323330, 1995 Jenkins KJ, Newburger JW, Lock JE, et al: In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95:323–330, 1995

    • Search Google Scholar
    • Export Citation
  • 25.

    Johnston SC: Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. Stroke 31:111117, 2000 Johnston SC: Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. Stroke 31:111–117, 2000

    • Search Google Scholar
    • Export Citation
  • 26.

    Kestle J, , Milner R, & Drake J: The shunt design trial: variation in surgical experience did not influence shunt survival. Pediatr Neurosurg 30:283287, 1999 Kestle J, Milner R, Drake J: The shunt design trial: variation in surgical experience did not influence shunt survival. Pediatr Neurosurg 30:283–287, 1999

    • Search Google Scholar
    • Export Citation
  • 27.

    Lawthers AG, , McCarthy EP, & Davis RB, et al: Identification of in-hospital complications from claims data. Is it valid? Med Care 38:785795, 2000 Lawthers AG, McCarthy EP, Davis RB, et al: Identification of in-hospital complications from claims data. Is it valid? Med Care 38:785–795, 2000

    • Search Google Scholar
    • Export Citation
  • 28.

    Lazareff JA, , Peacock W, & Holly L, et al: Multiple shunt failures: an analysis of relevant factors. Childs Nerv Syst 14:271275, 1998 Lazareff JA, Peacock W, Holly L, et al: Multiple shunt failures: an analysis of relevant factors. Childs Nerv Syst 14:271–275, 1998

    • Search Google Scholar
    • Export Citation
  • 29.

    Li V, & Dias MS: The results of a practice survey on the management of patients with shunted hydrocephalus. Pediatr Neurosurg 30:288295, 1999 Li V, Dias MS: The results of a practice survey on the management of patients with shunted hydrocephalus. Pediatr Neurosurg 30:288–295, 1999

    • Search Google Scholar
    • Export Citation
  • 30.

    Long DM, , Gordon T, & Bowman H, et al: Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. Neurosurgery 52:10561065, 2003 Long DM, Gordon T, Bowman H, et al: Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. Neurosurgery 52:1056–1065, 2003

    • Search Google Scholar
    • Export Citation
  • 31.

    Lund-Johansen M, , Svendsen F, & Wester K: Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon. Neurosurgery 35:839844, 1994 Lund-Johansen M, Svendsen F, Wester K: Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon. Neurosurgery 35:839–844, 1994

    • Search Google Scholar
    • Export Citation
  • 32.

    Mazumdar M, & Glassman JR: Categorizing a prognostic variable: review of methods, code for easy implementation and applications to decision-making about cancer treatments. Stat Med 19:113132, 2000 Mazumdar M, Glassman JR: Categorizing a prognostic variable: review of methods, code for easy implementation and applications to decision-making about cancer treatments. Stat Med 19:113–132, 2000

    • Search Google Scholar
    • Export Citation
  • 33.

    McCullagh P: Regression models for ordinal data. J R Stat Soc [B] 42:109142, 1980 McCullagh P: Regression models for ordinal data. J R Stat Soc [B] 42:109–142, 1980

    • Search Google Scholar
    • Export Citation
  • 34.

    Odio C, , McCracken GH Jr, & Nelson JD: CSF shunt infections in pediatrics. A seven-year experience. Am J Dis Child 138:11031108, 1984 Odio C, McCracken GH Jr, Nelson JD: CSF shunt infections in pediatrics. A seven-year experience. Am J Dis Child 138:1103–1108, 1984

    • Search Google Scholar
    • Export Citation
  • 35.

    Renier D, , Lacombe J, & Pierre-Kahn A, et al: Factors causing acute shunt infection. Computer analysis of 1174 operations. J Neurosurg 61:10721078, 1984 Renier D, Lacombe J, Pierre-Kahn A, et al: Factors causing acute shunt infection. Computer analysis of 1174 operations. J Neurosurg 61:1072–1078, 1984

    • Search Google Scholar
    • Export Citation
  • 36.

    Sanford RA: Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery. Pediatr Neurosurg 21:S39S43, 1994 Sanford RA: Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery. Pediatr Neurosurg 21:S39–S43, 1994

    • Search Google Scholar
    • Export Citation
  • 37.

    Shurtleff DB, , Stuntz JT, & Hayden PW: Experience with 1201 cerebrospinal fluid shunt procedures. Pediatr Neurosci 12:4957, 1985–1986 Shurtleff DB, Stuntz JT, Hayden PW: Experience with 1201 cerebrospinal fluid shunt procedures. Pediatr Neurosci 12:49–57, 1985–1986

    • Search Google Scholar
    • Export Citation
  • 38.

    Sollano JA, , Gelijns AC, & Moskowitz AJ, et al: Volume-outcome relationships in cardiovascular operations: New York State, 1990–1995. J Thorac Cardiovasc Surg 117:419430, 1999 Sollano JA, Gelijns AC, Moskowitz AJ, et al: Volume-outcome relationships in cardiovascular operations: New York State, 1990–1995. J Thorac Cardiovasc Surg 117:419–430, 1999

    • Search Google Scholar
    • Export Citation
  • 39.

    Solomon RA, , Mayer SA, & Tarmey JJ: Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. Stroke 27:1317, 1996 Solomon RA, Mayer SA, Tarmey JJ: Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. Stroke 27:13–17, 1996

    • Search Google Scholar
    • Export Citation
  • 40.

    Spiegelhalter DJ: Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data. BMJ 324:261263, 2002 Spiegelhalter DJ: Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data. BMJ 324:261–263, 2002

    • Search Google Scholar
    • Export Citation
  • 41.

    Stark J, , Gallivan S, & Lovegrove J, et al: Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 355:10041007, 2000 Stark J, Gallivan S, Lovegrove J, et al: Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 355:1004–1007, 2000

    • Search Google Scholar
    • Export Citation
  • 42.

    Steiner C, , Elixhauser A, & Schnaier J: The healthcare cost and utilization project: an overview. Eff Clin Pract 5:143151, 2002 Steiner C, Elixhauser A, Schnaier J: The healthcare cost and utilization project: an overview. Eff Clin Pract 5:143–151, 2002

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 668 225 20
Full Text Views 124 34 6
PDF Downloads 135 14 2
EPUB Downloads 0 0 0