title: Patient selection and clinical outcomes in patients operated for brain metastases--is specialty of the referring physicians a prognostic factor?
abstract: BACKGROUND
  As median survival in patients with brain metastases is short, but with wide confidence intervals, it is crucial to select the appropriate therapy. Various specialists diagnose brain metastases and refer selected patients to neurosurgical departments. There is, however, no robust and objective instrument for clinical decision making in individual patients with brain metastases. In consecutive patients treated with open surgery, we aimed to explore if clinical outcomes differed between the specialties of the referring physicians.
  
  
  METHODS
  We retrospectively included all adult (≥ 18 years) patients undergoing open surgery for brain metastases from 2004 through 2009 (n = 141). We divided the specialties of referring physicians in three groups; oncologists, pulmonologists and others.
  
  
  RESULTS
  59 patients (42%) were referred from oncologists, 24 (17%) referred from pulmonologists and 58 (41%) referred from other specialties. There was no significant association between the graded prognostic assessment score and clinical specialty (P = 0.366), reflecting similar referral practice. Twenty-four patients (17%) died within 3 months from surgery. There was no association between clinical specialty and 3 months mortality (P = 0.461). The perioperative mortality was 7% (n = 10), and we registered 19% (n = 27) complications. Risk of perioperative mortality (P = 0.448) or surgical complications (P = 0.330) were also not associated with the specialty of the referring clinician.
  
  
  CONCLUSIONS
  Patient selection and clinical outcomes did not differ between the specialties of referring physicians. We believe patient selection and outcomes were fairly similar between groups as a result of the multidisciplinary work-up between referring physicians and neurosurgeons. However, with 17% 3-month mortality there is still room for improvement in patient selection.
authors.affiliation: Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway. asgeir.s.jakola@ntnu.no
authors.forename: Asgeir S
authors.initials: AS
authors.lastname: Jakola
authors.forename: Sasha
authors.initials: S
authors.lastname: Gulati
authors.forename: Ulf S
authors.initials: US
authors.lastname: Nerland
authors.forename: Ole
authors.initials: O
authors.lastname: Solheim
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization / Q000706:statistics & numerical data*; D016896:Treatment Outcome