The study found far fewer complications for hospitals and doctors who were very experienced with brain tumor surgery. We at Columbia University Medical Center / New York Presbyterian Hospital are in the very experienced group, which does astronomically better.
Specifically, the study’s researchers examined adult “supratentorial” brain tumors. These are tumors located above the tentorium, a membrane that separates the majority of the brain from the cerebellum (see image above left). The study grouped doctors according to the number of brain tumor surgeries they performed during the ten years of the study. Likewise, the study grouped hospitals by the number of cases they handled in the same time period.
Dr. Michael Sisti, Dr. Guy McKhann, Dr. Jeffrey Bruce, Dr. Marc Otten, and Dr. Anthony D’Ambrosio from our Brain Tumor Center at Columbia Department of Neurosurgery specialize in the treatment of these types of tumors. According to the criteria of the study, they are each in the top 10% of doctors in the nation for experience performing these surgeries.
And the experience of this “most experienced” group pays off. There is a big difference in results between the group of surgeons who handled the fewest cases and the group who had handled the most, like the surgeons at our Brain Tumor Center.
The study found that other things–like whether the surgery was an emergency, or where a patient lived–could not account for these differences. Only the experience of the surgeon explained the differences.
Experience counts for a lot. The study’s authors suggest (in scientific-paper-speak) that “very-high-volume surgeons [may] acquire a degree of sophistication in their clinical decision-making and technical skill that contributes to more favorable outcomes.”
Or, in plain English, “practice makes perfect.”
This “practice makes perfect” philosophy is important to the Neurosurgery Department. We believe that a surgeon’s ability to subspecialize allows him or her to hone that “degree of sophistication… and technical skill” that the study’s authors mention. The results of the study are great news, as they confirm that our “practice makes perfect” philosophy provides a real, measurable benefit to our patients.
The news about Columbia University Medical Center / New York Presbyterian Hospital is also excellent. CUMC fell into the top 10% of hospitals for number of brain tumor surgery cases. This busy top tier of hospitals–like the most experienced surgeons–performed extremely well.
Complication rates, routine discharge rates, and in-hospital mortality rates were much better at the hospitals that had handled the most cases. And while the cutoff for the “top 10%” of hospitals was 40 or more brain tumor surgery cases each year, CUMC handled at least 120 each year.
The study’s authors propose that patients should be encouraged to receive their surgery from experienced surgeons at high-caseload hospitals (like CUMC/NYPH). Outcomes will be better for patients, and overall cost will be lower.
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