CLINICAL STUDY Trends in intracranial meningioma surgery and outcome: a Nationwide Inpatient Sample database analysis from 2001 to 2010 Sudheer Ambekar • Mayur Sharma • Venkatesh S. Madhugiri • Anil Nanda Received: 5 February 2013 / Accepted: 22 June 2013 Ó Springer Science+Business Media New York 2013 Abstract The objective of the present study was to ana- lyze the risk of in-patient mortality, adverse outcome, practice patterns and regional variations in patients who underwent intracranial meningioma surgery in the United States between 2001 and 2010. We performed a retro- spective cohort study using the Nationwide Inpatient Sample database. In-patient mortality and adverse outcome at discharge were the outcome predictors. Multivariate analyses were done to analyze the patient, hospital and physician characteristics. The annual case-volume of patients with meningioma increased from 2001 to 2010 by 40 %. The in-patient mortality rate remained the same at 1.3 % and the rate of adverse discharge disposition remained at 35 % between 2001 and 2010. Caucasian female patients in younger age group with private insur- ance who underwent treatment at a high case-volume center had the best outcomes. In older patients (C70 years), the in-patient mortality rate decreased by 25 % whereas the adverse discharge disposition rate increased by 19 %. Patients treated at high case-volume centers and by high case-volume physicians had lower rates of in-patient mortality (P \ 0.05) and adverse outcome at discharge (P = 0 \ 0.05). There was a 54 % decrease in the number of hospitals performing one surgery/year through the dec- ade. A 2 % relative decrease in mortality was observed in lowest volume hospitals. Though the highest increase in admission charges through the decade was seen in hospitals located in the north-east (165 % relative increase), the highest relative decrease in mortality and morbidity was observed in hospitals located in the mid-west and the south (67.6 and 22 % respectively). Keywords Meningioma Á Trends Á Nationwide Inpatient Sample Á Mortality Á Morbidity Introduction The treatment paradigms for intracranial meningiomas have been constantly evolving. Since the advent of radio- surgery, radical resection as the primary line of treatment for meningioma has taken a backseat and multi-modality management is being preferred by many physicians [1–4]. The purported benefits of more aggressive attempts to completely resect these tumors are a matter of debate. It is now generally accepted that such benefits may, by and large, be negligible when compared with less aggressive multi-modality approaches [5]. In a previous study, the mortality and adverse hospital discharge disposition rates were found to be lower when meningioma surgery was performed by high-volume providers [6]. In this analysis, we analyze the trends in practice pat- terns and the outcome of craniotomy for intracranial meningioma in the US between 2001 and 2010. In-hospital mortality and discharge disposition was correlated with patient characteristics and hospital and physician case- volumes. Electronic supplementary material The online version of this article (doi:10.1007/s11060-013-1183-6) contains supplementary material, which is available to authorized users. S. Ambekar Á M. Sharma Á V. S. Madhugiri Á A. Nanda (&) Department of Neurosurgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932, USA e-mail: ananda@lsuhsc.edu 123 J Neurooncol DOI 10.1007/s11060-013-1183-6