March 1, 2004Neurosurgery143 citations

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

ESEdward R. SmithBoston Children's Hospital WBWilliam E. ButlerHarvard University FBFred G. BarkerHarvard University

Structured PICO

Does higher provider and hospital caseload improve mortality and discharge disposition in pediatric brain tumor craniotomy?

Population

Pediatric patients undergoing craniotomy for brain tumor resection in the United States from 1988 to 2000

Intervention

Surgery performed at high-volume hospitals and by high-volume surgeons

Comparator

Surgery performed at lower-volume hospitals and by lower-volume surgeons

Outcome

Mortality and adverse discharge disposition rateshard clinical

Higher surgical volume at both the hospital and provider level is associated with improved outcomes for pediatric brain tumor resections.

Abstract

Mortality and adverse discharge disposition rates for pediatric brain tumor craniotomy were lower when the procedure was performed at high-volume hospitals and by high-volume surgeons in the United States, from 1988 to 2000. There were trends toward lower mortality rates, greater centralization of surgery, and more specialization among surgeons during this period.

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