International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study

Acta Neurochirurgica, vol. 164, pp. 385–392

Abstract

PURPOSE: Although standard-of-care has been defined for the treatment of glioblastoma patients, substantial practice variation exists in the day-to-day clinical management. This study aims to compare the use of laboratory tests in the perioperative care of glioblastoma patients between two tertiary academic centers-Brigham and Women's Hospital (BWH), Boston, USA, and University Medical Center Utrecht (UMCU), Utrecht, the Netherlands. METHODS: All glioblastoma patients treated according to standard-of-care between 2005 and 2013 were included. We compared the number of blood drawings and laboratory tests performed during the 70-day perioperative period using a Poisson regression model, as well as the estimated laboratory costs per patient. Additionally, we compared the likelihood of an abnormal test result using a generalized linear mixed effects model. RESULTS: After correction for age, sex, IDH1 status, postoperative KPS score, length of stay, and survival status, the number of blood drawings and laboratory tests during the perioperative period were 3.7-fold (p < 0.001) and 4.7-fold (p < 0.001) higher, respectively, in BWH compared to UMCU patients. The estimated median laboratory costs per patient were 82 euros in UMCU and 256 euros in BWH. Furthermore, the likelihood of an abnormal test result was lower in BWH (odds ratio [OR] 0.75, p < 0.001), except when the prior test result was abnormal as well (OR 2.09, p < 0.001). CONCLUSIONS: Our results suggest a substantially lower clinical threshold for ordering laboratory tests in BWH compared to UMCU. Further investigating the clinical consequences of laboratory testing could identify over and underuse, decrease healthcare costs, and reduce unnecessary discomfort that patients are exposed to.

Authors 14

1. Joeky T. Senders

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

2. Sybren L. N. Maas

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Pathology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

3. Kaspar Draaisma

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

4. John J. McNulty

   Brigham and Women's Hospital · Harvard University

   Affiliation as printed

   Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

   Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

5. Joanna L. Ashby

   Brigham and Women's Hospital · Harvard University

   Affiliation as printed

   Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

   Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

6. Imo Höfer

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

7. Wouter W. van Solinge

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

8. Maarten ten Berg

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

9. Tom Jan Snijders

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Neurology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

10. Tatjana Seute

    Utrecht University · University Medical Center Utrecht

    Affiliation as printed

    Department of Neurology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

11. Pierre A. J. T. Robe

    Utrecht University · University Medical Center Utrecht

    Affiliation as printed

    Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

12. William Brian Gormley

    Brigham and Women's Hospital · Harvard University

    Affiliation as printed

    Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

13. Timothy Richard Smith

    Brigham and Women's Hospital · Harvard University

    Affiliation as printed

    Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

14. Marike L. D. Broekman corresponding Aachen Department of Neurosurgery

    Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

    Affiliation as printed

    Department of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. m.broekman@haaglandenmc.nl

    Department of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands