Abstract
ObjectiveLength of hospital stay (LOS) is considered a vital component for successful colorectal surgery treatment. Evidence of an association between hospital surgery volume and LOS has been mixed. Data modelling techniques may give inconsistent results that adversely impact conclusions. This study applied techniques to overcome possible modelling drawbacks. MethodAn additive quantile regression model formulated to isolate hospital contextual effects was applied to every colorectal surgery for cancer conducted in Victoria, Australia, between 2005 and 2015, involving 28,343 admissions in 90 Victorian hospitals. The model compared hospitals’ operational efficiencies regarding LOS. ResultsHospital LOS operational efficiencies for colorectal cancer surgery varied markedly between the 90 hospitals and were independent of volume. This result was adjusted for pertinent patient and hospital characteristics. ConclusionNo evidence was found that higher annual surgery volume was associated with lower LOS for patients undergoing colorectal cancer surgery. Our model showed strong evidence that differences in LOS efficiency between hospitals was driven by hospital contextual effects that were not predicted by provider volume. Further study is required to elucidate these inherent differences between hospitals. Implications for public healthOur model indicated improved efficiency would benefit the patient and medical system by lowering LOS and reducing expenditure by more than $3 million per year.
Highlights
MethodsThe Victorian Admitted Episode Dataset (VAED) includes all separations (discharges and transfers) undertaken within all Victorian hospitals
No evidence was found that higher annual surgery volume was associated with lower Length of hospital stay (LOS) for patients undergoing colorectal cancer surgery
Our model showed strong evidence that differences in LOS efficiency between hospitals was driven by hospital contextual effects that were not predicted by provider volume
Summary
The Victorian Admitted Episode Dataset (VAED) includes all separations (discharges and transfers) undertaken within all Victorian hospitals. As it was conceivable that LOS and provider volume were not necessarily linearly related, we used an additive quantile regression (AQR) model that does not require a predetermined functional fit but instead determines the best fit from the data.[34,44,45,46] Provider volume was defined as the number of colorectal surgical procedures performed by a hospital within a fiscal year (1 July to 30 June), whether patients had a principal diagnosis of CRC or not; that is, annual volume (AV). Not all hospitals performed colorectal surgical procedures in every study year.[19] The within effect was modelled by AV It estimated the effect on LOS within hospitals as AV varied and its interpretation is equivalent to any fixed effect estimator.[48] The between effect was modelled by MAV. Due to the model formulation used, it estimated the effect on LOS if a patient were to attend another hospital with a different MAV, that is, the hospital contextual effect.[39,40,42] This method draws comparisons across hospitals and estimates the effect of hospital choice on patient LOS or, in other words, hospitals’ quality of care or efficiency regarding LOS.[42]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Australian and New Zealand Journal of Public Health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
