Intracranial Meningioma Surgery: Value-Based Care Determinants in New York State, 1995e2015 Sean P. McKee 1 , Anthony Yang 1 , Mingyang Gray 1 , Joshua Zeiger 1 , Joshua B. Bederson 2 , Satish Govindaraj 1 , Alfred M.C. Iloreta 1 , Raj K. Shrivastava 2 - OBJECTIVE: Intracranial meningiomas are the most commonly diagnosed brain tumor in the United States. With increasing incidence, efficient allocation of limited health care resources is a critical component of emerging value- based models of care. The purpose of this study was to evaluate the effect of patient and hospital variables on metrics of value-based care. - METHODS: The Statewide Planning and Research Cooperative System database was queried for records of patients undergoing intracranial meningioma surgery in New York State from 1995 to 2015. Multivariate logistic regression was used to investigate the effect of hospital volume and patient demographics on 30-day readmissions, 30-day mortality, prolonged length of stay (pLOS), and excess hospital charges. - RESULTS: Among the 14,239 patients included, 10,252 (72%) cases were performed at high-volume centers (HVC) (>75th percentile). HVC were associated with lower rates of readmissions, mortality, and pLOS, but higher hospital charges. In the multivariate analysis, HVC had reduced odds of pLOS (odds ratio, 0.56; P < 0.0001) and 30-day mortality (odds ratio, 0.39; P < 0.0001). Patient variables associated with adverse outcomes in the multivariate model included advanced age, male gender, higher Charl- son Comorbidity Index, lower socioeconomic status (low income, Medicaid, and Medicare insurance), black race, and Hispanic ethnicity. These populations were more likely to undergo treatment at lower-volume centers. - CONCLUSIONS: This statewide population analysis of readmissions, mortality, length of stay, and hospital charges after intracranial meningioma surgery identified patient predictors of adverse outcomes. These de- terminants may be used by hospitals to develop improved systems of care in at-risk populations. INTRODUCTION T he assessment of surgical value is complex and involves the evaluation of multiple components within the health care delivery chain, including structural systems of care, delivery processes, and outcomes. 1 The surgical volume of an institution can influence all these components from the surgical and intensive care facilities and technologies to the skill and expertise of the surgical team, often resulting in widely divergent patient outcomes. 1 Surgical value related to the treatment of meningiomas is of particular interest because they account for most brain tumors and require multidisciplinary teams of neurosurgeons, otolaryngologists, neurointensivists, neuro-ophthalmologists, and neuropathologists, as well as radia- tion and medical oncologists. 2-4 In the early 2000s, several studies reported improved outcomes at high-volume neurosurgical centers for measures including length of stay (LOS), mortality, discharge Key words - Affordable Care Act - Disparities - Intracranial meningioma surgery - Outcomes - Value-based care Abbreviations and Acronyms CCI: Charlson Comorbidity Index CI: Confidence interval HVC: High-volume center LOS: Length of stay LVC: Low-volume center MVC: Moderate-volume center NYS: New York State OR: Odds ratio pLOS: Prolonged length of stay ZIP: Zone improvement plan From the 1 Department of OtolaryngologyeHead and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; and 2 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA To whom correspondence should be addressed: Raj K. Shrivastava, M.D. [E-mail: raj.shrivastava@mountsinai.org] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.07.030 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e14, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article