Hospital teaching status associated with reduced inpatient mortality and perioperative complications in surgical neuro-oncology.

PURPOSE: Studies have demonstrated that higher surgical volumes correlate with improved neurosurgical outcomes yet none exist evaluating the effects of hospital teaching status on the surgical neuro-oncology patient. We present the first analysis comparing brain tumor surgery perioperative outcomes at academic and non-teaching centers. METHODS: Brain tumor surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. A teaching hospital, defined by the NIS, must have ≥ 1 Accreditation Council of Graduate Medical Education (ACGME) approved residency programs, Council of Teaching Hospitals membership, or have a ratio ≥ 0.25 of full-time residents to hospital beds. Annual treatment trends were stratified by hospital teaching status, assessing yearly caseload with linear regression. Multivariable logistic regression determined predictors of inpatient mortality/complications. Hospitals were further divided into quartiles by case volume and teaching status was compared in each. RESULTS: Teaching hospitals (THs) exhibited an average annual increase in brain tumor surgeries (+ 1057/year, p < 0.0001). In multivariable analysis, teaching status was associated with decreased risk of mortality (OR 0.82, p = 0.0003) and increased likelihood of discharge home (OR 1.21, p < 0.0001). In subgroup analysis, within the highest hospital quartile by caseload, higher mortality rates and lower routine discharges were again seen at non-teaching hospitals (NTHs) (p = 0.0002 and p = 0.0016, respectively). CONCLUSION: THs are performing more brain tumor surgeries over time with lower rates of inpatient mortality and perioperative complications even after controlling for hospital case volume. These results suggest a shift in neuro-oncology practice patterns favoring THs to optimize patient outcomes especially at the highest volume centers.

Hip and waist circumference correlations with demographic factors and pain intensity in patients with chronic pain.

Aim: This study aimed to investigate how demographic factors such as race, age, sex and ethnicity can impact hip circumference (HC) and waist circumference (WC) in patients with chronic pain.Materials & methods: We queried the NIH-sponsored All of Us database for patients with documented HC, WC and waist/hip ratio (WHR) data. This cross-sectional study categorized participants into four groups: total cohort, no chronic pain, mild/moderate chronic pain (numeric rating scale < 7) and severe chronic pain (numeric rating scale > 7). Further subgroup analyses were performed based on race, age, sex and ethnicity. We examined the correlation between chronic pain and WC, HC and WHR. ANCOVA analysis was used to determine to investigate demographics.Results: This study included 204,013 participants, with 25.22% having a chronic pain diagnoses. In most subgroups, females had significantly greater HC, while males had greater WC and WHR. WC (p < 0.001 in females, p < 0.01 in males), HC (p < 0.001 in females) and WHR (p < 0.001 in females, p < 0.05 in males) were significantly greater in the severe pain group compared with the mild/moderate pain group.Conclusion: These findings suggest that when assessing HC and WC, demographic variables need to be considered to develop more personalized and comprehensive treatment plans for chronic pain patients.

Our study looked at how factors like race, age, sex and ethnicity relate to hip and waist sizes in people with chronic pain. We wanted to see whether waist and hip measurements that lead to chronic pain is associated with race, age, sex and ethnicity. We used information from a database of patients with chronic pain formed in the USA. We grouped people based on how much pain they had (none, mild/moderate, severe) and then looked for differences between races, ages, sexes and ethnicities. Among men of all races, those with mild to moderate pain tended to have larger waists compared with those without pain. For women, those who experienced severe pain had larger waists and hips.We addressed how race, age, sex and ethnicity are associated with these results. Our main finding is that doctors should consider not just hip and waist sizes but also a patient's demographic background. This can help them create better treatment plans to determine risks of developing pain and individualizing treatment.