University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Neurological Surgery, University of Minnesota, 420 Delaware St SE, MMC 96, Room D-429, Minneapolis, MN, 55455, USA.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Internal Medicine Department, Hennepin Healthcare, Minneapolis, MN, USA.
目的
了解影响技术传播的因素是新疗法临床转化的核心。我们使用国家住院样本 (NIS) 数据库描述了神经肿瘤学中激光间质热疗 (LITT)（也称为立体定向激光消融 (SLA)）的采用模式。
方法
我们在 NIS（2012-2018）中确定了年龄≥18 岁且诊断为原发性或转移性脑肿瘤并接受 LITT 或开颅手术的患者。我们比较了接受这些手术的患者的特征和结果。
结果
在研究期间，相对于开颅手术，LITT 的利用率增加了约 400%。尽管有这种增加，但对脑肿瘤进行的 LITT 手术总数小于开颅手术的 1%。调整此时间趋势后，LITT 患者出现 > 2 种合并症（OR 0.64，CI
95
0.51–0.79）或年龄较大（OR 0.92，CI
95
0.86–0.99）的可能性较小，女性的可能性更大（OR 1.35 , CI
95
1.08–1.69)，白种人与黑人的比较（OR 1.94，CI
95
1.12–3.36），并且与 Medicare 或 Medicaid 相比，由私人保险承保（OR 1.38，CI
95
1.09–1.74）。LITT 住院时间比开颅手术短 50%（IRR 0.52，CI
95
0.45–0.61）。然而，LITT 和开颅手术相关的手术费用相当（LITT 高出 1397 美元，CI
95
美元 -5790 美元至 8584 美元）。
结论
对于神经肿瘤学适应症，相对于开颅手术，LITT 的利用率增加了约 400%。相对于开颅手术治疗的患者，LITT 治疗的患者更有可能是年轻、女性、非黑人种族、私人保险承保或合并症 < 2。虽然住院总费用相当，但 LITT 与开颅手术相比住院时间更短。
Purpose
Understanding factors that influence technology diffusion is central to clinical translation of novel therapies. We characterized the pattern of adoption for laser interstitial thermal therapy (LITT), also known as stereotactic laser ablation (SLA), in neuro-oncology using the National Inpatient Sample (NIS) database.
Methods
We identified patients age ≥ 18 in the NIS (2012–2018) with a diagnosis of primary or metastatic brain tumor that underwent LITT or craniotomy. We compared characteristics and outcomes for patients that underwent these procedures.
Results
LITT utilization increased ~ 400% relative to craniotomy during the study period. Despite this increase, the total number of LITT procedures performed for brain tumor was < 1% of craniotomy. After adjusting for this time trend, LITT patients were less likely to have > 2 comorbidities (OR 0.64, CI
95
0.51–0.79) or to be older (OR 0.92, CI
95
0.86–0.99) and more likely to be female (OR 1.35, CI
95
1.08–1.69), Caucasian compared to Black (OR 1.94, CI
95
1.12–3.36), and covered by private insurance compared to Medicare or Medicaid (OR 1.38, CI
95
1.09–1.74). LITT hospital stays were 50% shorter than craniotomy (IRR 0.52, CI
95
0.45–0.61). However, charges related to the procedures were comparable between LITT and craniotomy ($1397 greater for LITT, CI
95
$−5790 to $8584).
Conclusion
For neuro-oncology indications, LITT utilization increased ~ 400% relative to craniotomy. Relative to craniotomy-treated patients, LITT-treated patients were likelier to be young, female, non-Black race, covered by private insurance, or with < 2 comorbidities. While the total hospital charges were comparable, LITT was associated with a shorter hospitalization relative to craniotomy.
