Rebecca Clarke, Maeve Colleran, Gail Melanophy, Margaret Bermingham
Enhancing the clinical pharmacy service of a large teaching hospital: Development of a new clinical prioritisation tool
Exploratory research in clinical and social pharmacy
objective patient demographic characteristics hospital volume admission status shown impact surgical outcomes sellar region tumors adults however data available following resection craniopharyngiomas pediatric population remain limited authors sought identify potential risk factors associated outcomes following surgical management pediatric craniopharyngiomas methods nationwide inpatient sample database kids inpatient database analyzed include admissions pediatric patients 18 years underwent transcranial transsphenoidal craniotomy resection craniopharyngioma patientlevel factors including age race comorbidities insurance type well hospital factors collected outcomes analyzed included mortality rate endocrine nonendocrine complications hospital charges length stay multivariate model controlling variables analyzed constructed examine significant independent risk factors results 2000 2011 1961 pediatric patients identified underwent transcranial 712 transsphenoidal 288 craniotomy resection craniopharyngioma major predilection age observed selection transcranial 234 7yearolds 281 7 12yearolds 197 13 18yearolds versus transphenoidal 29 7yearolds 74 7 12yearolds 184 13 18yearolds approach significant outcomes associated particular surgical approach except 7 12yearold patients higher risk nonendocrine complications relative risk rr 242 95 ci 104565 p 004 transsphenoidal approach compared 13 18yearold patients overall inpatient mortality rate 05 common postoperative complication diabetes insipidus 642 independent factors associated inpatient mortality rates significant differences outcomes among groups based sex race average length stay 118 days mean hospital charge 1165 22 hospitals medium large bed capacity protective nonendocrine complications rr 053 95 ci 03093 p 003 medium rr 045 95 ci 02508 p 001 large total complications rr 073 95 ci 055097 p 003 medium rr 068 95 ci 05109 p 001 large compared hospitals small bed capacity 200 beds patients admitted rural hospitals increased risk nonendocrine complications rr 256 95 ci 11159 p 003 presence one medical comorbidities increased risk higher total complications rr 138 95 ci 114168 p 001 1 comorbidity rr 237 95 ci 198284 p 001 2 comorbidities higher total hospital charges rr 29 95 ci 108781 p 004 1 comorbidity rr 91 95 ci 3742212 p 001 2 comorbidities conclusions analysis identified patient age comorbidities insurance type hospital bed capacity rural nonteaching hospital status independent risk factors postoperative complications andor increased hospital charges pediatric patients craniopharyngioma transsphenoidal surgery younger patients craniopharyngioma risk factor nonendocrine complications