Microvascular decompression surgery in the United States, 1996 to 2000

Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes

Steven N. Kalkanis, Emad N. Eskandar, Bob S. Carter, Fred G. Barker, Albino Bricolo, Kenneth F. Casey, Peter J. Jannetta, Bruce E. Pollock, Kim J. Burchiel

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

OBJECTIVE: Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS: The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3%, and the rate of discharge other than to home was 3.8%. Neurological complications were coded in 1.7% of cases, hematomas in 0.5%, and facial palsies in 0.6%, with 0.4% of patients requiring ventriculostomies and 0.7% postoperative ventilation. Trigeminal nerve section was also coded for 3.4% of patients with trigeminal neuralgia, more commonly among older patients (P = 0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1-195 cases) and 3 cases per surgeon (range, 1-107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1% for the lowest-volume-quartile hospitals, compared with 1.6% for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION: Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.

Original languageEnglish (US)
Pages (from-to)1251-1262
Number of pages12
JournalNeurosurgery
Volume52
Issue number6
DOIs
StatePublished - Jun 1 2003
Externally publishedYes

Fingerprint

Microvascular Decompression Surgery
High-Volume Hospitals
Morbidity
Trigeminal Neuralgia
Mortality
Glossopharyngeal Nerve Diseases
Hemifacial Spasm
Low-Volume Hospitals
Ventriculostomy
Hospital Charges
Trigeminal Nerve
Facial Paralysis
Insurance
Teaching Hospitals
Hematoma
Ventilation
Surgeons
Comorbidity
Inpatients
Length of Stay

Keywords

  • Microvascular decompression
  • Mortality rate
  • Volume-outcome relationship

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Microvascular decompression surgery in the United States, 1996 to 2000 : Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. / Kalkanis, Steven N.; Eskandar, Emad N.; Carter, Bob S.; Barker, Fred G.; Bricolo, Albino; Casey, Kenneth F.; Jannetta, Peter J.; Pollock, Bruce E.; Burchiel, Kim J.

In: Neurosurgery, Vol. 52, No. 6, 01.06.2003, p. 1251-1262.

Research output: Contribution to journalArticle

Kalkanis, Steven N. ; Eskandar, Emad N. ; Carter, Bob S. ; Barker, Fred G. ; Bricolo, Albino ; Casey, Kenneth F. ; Jannetta, Peter J. ; Pollock, Bruce E. ; Burchiel, Kim J. / Microvascular decompression surgery in the United States, 1996 to 2000 : Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. In: Neurosurgery. 2003 ; Vol. 52, No. 6. pp. 1251-1262.
@article{fa72bff08fe946d88f295a35ab60a6dc,
title = "Microvascular decompression surgery in the United States, 1996 to 2000: Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes",
abstract = "OBJECTIVE: Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS: The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3{\%}, and the rate of discharge other than to home was 3.8{\%}. Neurological complications were coded in 1.7{\%} of cases, hematomas in 0.5{\%}, and facial palsies in 0.6{\%}, with 0.4{\%} of patients requiring ventriculostomies and 0.7{\%} postoperative ventilation. Trigeminal nerve section was also coded for 3.4{\%} of patients with trigeminal neuralgia, more commonly among older patients (P = 0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1-195 cases) and 3 cases per surgeon (range, 1-107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1{\%} for the lowest-volume-quartile hospitals, compared with 1.6{\%} for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION: Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.",
keywords = "Microvascular decompression, Mortality rate, Volume-outcome relationship",
author = "Kalkanis, {Steven N.} and Eskandar, {Emad N.} and Carter, {Bob S.} and Barker, {Fred G.} and Albino Bricolo and Casey, {Kenneth F.} and Jannetta, {Peter J.} and Pollock, {Bruce E.} and Burchiel, {Kim J.}",
year = "2003",
month = "6",
day = "1",
doi = "10.1227/01.NEU.0000065129.25359.EE",
language = "English (US)",
volume = "52",
pages = "1251--1262",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Microvascular decompression surgery in the United States, 1996 to 2000

T2 - Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes

AU - Kalkanis, Steven N.

AU - Eskandar, Emad N.

AU - Carter, Bob S.

AU - Barker, Fred G.

AU - Bricolo, Albino

AU - Casey, Kenneth F.

AU - Jannetta, Peter J.

AU - Pollock, Bruce E.

AU - Burchiel, Kim J.

PY - 2003/6/1

Y1 - 2003/6/1

N2 - OBJECTIVE: Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS: The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3%, and the rate of discharge other than to home was 3.8%. Neurological complications were coded in 1.7% of cases, hematomas in 0.5%, and facial palsies in 0.6%, with 0.4% of patients requiring ventriculostomies and 0.7% postoperative ventilation. Trigeminal nerve section was also coded for 3.4% of patients with trigeminal neuralgia, more commonly among older patients (P = 0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1-195 cases) and 3 cases per surgeon (range, 1-107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1% for the lowest-volume-quartile hospitals, compared with 1.6% for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION: Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.

AB - OBJECTIVE: Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS: The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3%, and the rate of discharge other than to home was 3.8%. Neurological complications were coded in 1.7% of cases, hematomas in 0.5%, and facial palsies in 0.6%, with 0.4% of patients requiring ventriculostomies and 0.7% postoperative ventilation. Trigeminal nerve section was also coded for 3.4% of patients with trigeminal neuralgia, more commonly among older patients (P = 0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1-195 cases) and 3 cases per surgeon (range, 1-107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1% for the lowest-volume-quartile hospitals, compared with 1.6% for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION: Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.

KW - Microvascular decompression

KW - Mortality rate

KW - Volume-outcome relationship

UR - http://www.scopus.com/inward/record.url?scp=0037603532&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037603532&partnerID=8YFLogxK

U2 - 10.1227/01.NEU.0000065129.25359.EE

DO - 10.1227/01.NEU.0000065129.25359.EE

M3 - Article

VL - 52

SP - 1251

EP - 1262

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 6

ER -