Average surgeon-level volume and hospital performance

Abstract

This study evaluates the relationships among the average number of procedures per surgeon, calculated across the entire hospital, and multiple dimensions of overall hospital operational performance. Hospital administrative data from 154 public and private hospitals in the state of New York were augmented by data from the Centers for Medicare and Medicaid Services. The data included administrative surgical records across all clinical areas for the year 2009. The study used maximum likelihood estimation path analysis to simultaneously test the relationships among average surgical volume and risk-adjusted length of stay, cost, and mortality, across all surgical procedures and clinical areas. The results showed that higher average volume per surgeon, computed across all surgical procedures in a hospital, was directly related to lower risk-adjusted length of stay, and indirectly related to lower risk-adjusted cost and mortality. A higher average number of procedures per surgeon may provide greater hospital-specific experience, including interactions among surgical teams and with other areas of the hospital, leading to better overall outcomes. This study advances the literature in health care operations management by examining the relationships among surgical volume, across all clinical areas and all types of surgeries, and three different dimensions of hospital performance.