Article
Quality indicators in meningioma surgery – analysis of the suitability of currently suggested quality indicators
Qualitätsindikatoren in der Meningeomchirurgie Analyse der Tauglichkeit der bestehenden gängigen Qualitätsindikatoren
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Published: | May 25, 2022 |
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Outline
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Objective: Risk stratification based on standardized quality measures has become crucial in neurosurgery. Contemporary quality indicators have often been collectively developed for a wide range of neurosurgical procedures. While these indicators are easy to register, their accuracy for tumor inherent characteristics of patients diagnosed with meningioma remain questionable. The objective of this study was the analysis of currently applied quality indicators in meningioma surgery and the identification of potential new measures.
Methods: Data of 133 patients that were operated due to meningioma between 2017 and 2019 were subject to analysis. The primary outcomes of interest were classical quality indicators such as the 30-days readmission-, 30-day reoperation-, 30-day mortality-, 30-day nosocomial infection- and the 30-day surgical site infection rate. The occurrence of a new postoperative neurological deficit was analyzed as a potential new quality indicator.
Results: 36 males and 97 females with a median age of 60 years (range: 22-91 years), in mainly good general condition (91% with ECOG 0-1), were included. The overall unplanned readmission rate was 3.8%, 13 patients were reoperated within 30 days (9.8%). The main reason for readmission was CSF-fistula (n=2, 60%), whereas postoperative hemorrhage was the most common indication for revision surgery (n=7, 54%). In multivariate analysis, nosocomial infections (OR=16.64, 95%-CI=2.63-102.25, p=.003) and depression (OR=10.96, 95%-CI=1.51-79.35, p=.018) could be identified as risk factors for 30-day reoperation. The 30-day nosocomial infection- and surgical site infection rates were 6.8% and 1.5%, respectively. The 30-day mortality rate was 0.8 % (n=1). A postoperative new neurological deficit or neurological deterioration was observed in 12 patients (9.0%). The edema volume on preoperative scans has proved to have a significant impact on the occurrence of a new postoperative neurological deficit (OR=1.011, 95%-CI=1.001-1.021, p= .023).
Conclusion: Classical quality indicators in neurosurgery have proved to correlate with considerable deterioration of the patient´s health in meningioma surgery and thus are recommended for application in meningioma patients. The occurrence of a new postoperative neurological deficit is common and procedure specific. Thus, this measure is recommended to be applied as a complementary quality indicator in meningioma surgery.