Impact of adjuvant interstitial brachytherapy on lengths of stay, discharge disposition, and 30-/90-day readmission for malignant brain tumor patients: a National Readmission Database analysis

Abstract

Purpose: Advances in interstitial brachytherapy for brain cancers have revived interest in this treatment platform. However, the impact of this therapy on hospital quality measures remains poorly characterized. Here we utilized the National Readmission Database (NRD) to address this gap in knowledge. Methods: We identified patients with malignant brain tumors who had undergone either craniotomies (C) for tumor resection or craniotomies augmented with adjuvant interstitial brachytherapy (C+IB) in the National Readmission Database (NRD, 2010-2018). Propensity-score weighting and survey regression techniques were used for analysis. Results: Over the study period, the number of craniotomies with adjuvant interstitial brachytherapy (C+IB) steadily decreased. For brain metastasis (BM) patients, C+IB and C patients exhibited comparable length of hospital stay (aIRR:1.01, CI₉₅:0.86-1.18, p=0.918) and routine discharge to home or self-care (aOR:0.95, CI₉₅:0.61-1.50, p=0.838). However, primary brain tumor (PBT) patients who underwent C+IB showed longer hospital stay (aIRR:1.43, CI₉₅:1.03-1.99, p=0.032) and are less likely to undergo routine discharge (aOR: 0.38, CI₉₅:0.20-0.74, p=0.005) relative to the C cohort. Despite these differences, C+IB and C patients showed comparable 30- or 90- day readmission risk. The profile of readmission diagnoses was also similar. Cost-analysis suggests that IB increased the median total charge by $19,184 (p=0.003). Conclusions: Our NRD analysis suggests that adjuvant interstitial brachytherapy did not alter hospital course/readmission risk for brain metastasis patients. However, primary brain tumor patients who underwent this therapy showed longer hospitalization and increased likelihood for non-routine discharge.