Fall 2003 Volume 16, Number 2

And a Last Word About Neurosurgery

Recent news has carried stories about comparing surgeries at large academic medical centers with those at smaller, lower-volume hospitals. Most of the studies, especially of high-risk operations, come out on the side of the regional medical centers. Here's yet another, this time about craniotomy for tumors. As reported in the journal Neurosurgery (2003;52:1056-1065), a Hopkins research team led by neurosurgeon Donlin Long, M.D., and Neurosurgeon in Chief Henry Brem, M.D., compared the operation's outcome at 33 nonfederal acute-care hospitals in Maryland. A total of 4,723 patients, age 18 or older, who'd had a craniotomy for benign tumor or for primary or secondary cancers was chosen. The team compared in-hospital deaths, length of stay and charges. Assuming patients' overall disease was similar, the team found rate of death was 2.5 percent at the large centers, compared with 4.9 percent at the lower-volume hospitals. Average charges were about $1,000 higher at the large centers, and patients' length of stay was, on average, two days less. If all tumor patients in the state having a craniotomy had large-center survival rates, 46 patients wouldn't have died.