Impact Of Hospital Volume Research Articles

Association of hospital volume with survival but not with postoperative mortality in glioblastoma patients in Belgium

ObjectivesStandard of care treatment for glioblastoma (GBM) involves surgical resection followed by chemoradiotherapy. However, variations in treatment decisions and outcomes exist across hospitals and physicians. In Belgium, where oncological care is dispersed, the impact of hospital volume on GBM outcomes remains unexplored. This nationwide study aims to analyse interhospital variability in 30-day postoperative mortality and 1-/2-year survival for GBM patients.MethodsData collected from the Belgian Cancer Registry, identified GBM patients diagnosed between 2016 and 2019. Surgical resection and biopsy cases were identified, and hospital case load was determined. Associations between hospital volume and mortality and survival probabilities were analysed, considering patient characteristics. Statistical analysis included logistic regression for mortality and Cox proportional hazard models for survival.ResultsA total of 2269 GBM patients were identified (1665 underwent resection, 662 underwent only biopsy). Thirty-day mortality rates post-resection/post-biopsy were 5.1%/11.9% (target < 3%/<5%). Rates were higher in elderly patients and those with worse WHO-performance scores. No significant difference was found based on hospital case load. Survival probabilities at 1/2 years were 48.6% and 21.3% post-resection; 22.4% and 8.3% post-biopsy. Hazard ratio for all-cause death for low vs. high volume centres was 1.618 in first 0.7 year post-resection (p < 0.0001) and 1.411 in first 0.8 year post-biopsy (p = 0.0046).ConclusionWhile 30-day postoperative mortality rates were above predefined targets, no association between hospital volume and mortality was found. However, survival probabilities demonstrated benefits from treatment in higher volume centres, particularly in the initial months post-surgery. These variations highlight the need for continuous improvement in neuro-oncological practice and should stimulate reflection on the neuro-oncological care organisation in Belgium.

The impact of hospital volume on the prognosis of patients with cardiogenic shock requiring mechanical circulatory support

Abstract Background Short-term mechanical circulatory support (MCS) is indicated in refractory cardiogenic shock (CS). Each hospital's volume of MCS relates to the many factors including population served, clinician experience and availability of MCS. To establish regional integrated Hub-and-spoke care CS systems for improving the prognosis of patients with CS, detailed data on relationship between the volume of MCS and prognosis are required but are lacking. We evaluated the relationship between outcomes, including in-hospital mortality and case volume, and explored whether there is an upper limit to this relationship. Methods We used the Japanese nationwide database to identify patients receiving short-term MCS for CS between April 2012 and March 2020. Of 65,837 patients receiving short-term MCS, three sub-cohorts were created based on the MCS type used; the intra-aortic balloon pump (IABP) alone (n=48,643), the extracorporeal membrane oxygenation (ECMO) (n=16,871), and the Impella cohorts (n=696). Results The median volume of annual cases in each hospital was 13.5 (7.4–22.1) in the IABP alone cohort, 6.4 (3.4-11.0) in the ECMO cohort, and 7.5 (4.0–10.7) in the Impella cohort. In the IABP alone and ECMO cohorts, the group with the higher case volume had less acute myocardial infarctions and received right heart catheterization more frequently. The highest quintile for the volume of cases in the IABP alone and ECMO cohorts had the lowest in-hospital mortality (IABP alone cohort, 25.1% in quintile 1 vs. 15.2% in quintile 5; ECMO cohort, 73.7% in quintile 1 in 67.4% in quintile 5), while it had the highest cost. Adjusted odds ratios for in-hospital mortality increased as case volume increased (IABP alone cohort, 0.63 [0.58–0.68] in quintile 5; ECMO cohort, 0.73 [0.65–0.82] in quintile 5, with the lowest quintile as reference) but did not increase significantly in the Impella cohort (0.90 [0.58–1.39] in tertile 3, with the lowest tertile as reference) (Figure 1). In continuous models, in-hospital mortality decreased to 28 cases/year in the IABP alone cohort and 12 cases/year in the ECMO cohort, and the mortality became almost flat above that (Figure 2). Hospitals with 28 or more cases/year in the IABP cohort were 3.6 % including 15.5 % of patients, and hospitals with 12 or more cases/year in the ECMO cohort were 4.7% including 20.9% of patients. Conclusions Higher volumes of IABP and ECMO are associated with a lower mortality. There is an upper limit to the decline, above which in-hospital mortality remains constant or increases slightly. Centralizing patients with refractory cardiogenic shock in a particular hospital might improve patient outcomes in each region.

Big data and RCT's in surgical oncology: Impact on improving hepatopancreatobiliary cancer surgical care on the global stage.

Randomized controlled clinical trials (RCTs) are at the heart of "evidence-based" medicine. Conducting well-designed RCTs for surgical procedures is often challenged by inadequate recruitment accrual, blinding, or standardization of the surgical procedure, as well as lack of funding and evolution of the treatment strategy during the many years over which such trials are conducted. In addition, most clinical trials are performed in academic high-volume centers with highly selected patients, which may not necessarily reflect a "real-world" practice setting. Large databases provide easy and inexpensive access to data on a large and diverse patient population at a variety of treatment centers. Furthermore, large database studies provide the opportunity to answer questions that would be impossible or very arduous to answer using RCTs, including questions regarding health policy efficacy, trends in surgical practice, access to health care, the impact of hospital volume, and adherence to practice guidelines, as well as research questions regarding rare disease, infrequent surgical outcomes, and specific subpopulations. Prospective data registries may also allow for quality benchmarking and auditing. There are several high-quality RCTs providing evidence to support current practices in hepatopancreatobiliary (HPB) oncology. Evidence from big data bridges the gap in several instances where RCTs are lacking. In this article, we review the evidence from RCTs and big data in HPB oncology identify the existing lacunae, and discuss the future directions of research in HPB oncology.

Impact of Hospital Volume on Long-Term Outcomes After Endovascular Therapy for Peripheral Artery Disease.

To investigate the association between annual hospital volume of endovascular therapy (EVT) and long-term outcomes in patients with lower-extremity peripheral artery disease (PAD). We identified patients who underwent percutaneous endovascular transluminal angioplasty and thrombectomy of the extremities or percutaneous endovascular removal in the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2020 linked to the Survey of Medical Institutions data. A generalized linear model analysis was performed to assess 12-month amputation, all-cause death, composite outcome (amputation and death), and readmission. We also analyzed length of hospital stay and total health care costs during the first hospitalization. Among 127 486 eligible patients, 31 579, 31 913, 31 999, and 31 995 were in the first (1-27 cases/year), second (28-44 cases), third (45-67 cases), and fourth (68-289 cases) quartiles, respectively. There were no significant differences in 12-month amputation among the second (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.90-1.04), third (OR, 1.00; 95% CI, 0.93-1.07), and fourth (OR, 1.00; 95% CI, 0.93-1.07) quartile volumes compared with the first quartile. Significant differences were observed in 12-month death (OR for fourth quartile with reference to the first quartile, 0.71; 95% CI, 0.65-0.76), composite outcome (OR, 0.84; 95% CI, 0.80-0.89), and readmission (OR, 1.05; 95% CI, 1.02-1.09). We found that the annual hospital volume of EVT was not associated with decreased 12-month amputation in patients with lower-extremity PAD. In contrast, all-cause death and composite outcome were significantly decreased in hospitals with the highest volume. The association between hospital volume of endovascular therapy and long-term adverse clinical outcomes remains unclear. The present analyses showed no significant differences in 12-month amputation rates among the hospital volumes, whereas higher-volume quartiles were significantly associated with decreased 12-month all-cause death rates and composite outcome. There was also a positive association in the length of stay between the first quartile volume and the others, while no significant difference in total health care costs among the quartiles was observed. Further investigations are needed, including insights into operator volume and procedural characteristics, to clarify the relationship between hospital volume and long-term adverse outcomes.

Impact of hospital volume and margin status on survival following radical hysterectomy: An expanded NCDB study.

e17527 Background: Use of a minimally invasive surgical (MIS) approach to manage early-stage cervical cancer has been previously associated with an elevated risk of disease recurrence and death. However, the reasons why MIS would lead to worse clinical outcomes remains unclear. Here, we sought to determine whether hospital surgical volume and surgical margin status contribute to worse outcomes previously reported for minimally invasive radical hysterectomy (RH-MIS). Methods: Demographic and outcome data for women diagnosed with an invasive carcinoma of the cervix (SCCa) between 2010 and 2015 were abstracted from the National Cancer Database (NCDB). Differences by surgery type were examined using chi-square test for categorical variables and independent samples t-test test for continuous variables. Surgical margin status was reported as either positive or negative according to the presence of malignancy. Overall survival was evaluated using the Kaplan-Meier method and multivariable Cox proportional hazards regression. Analyses were stratified by hospital volume. Low volume facilities were defined as institutions performing &lt;10 surgeries per year. Results: We identified a total of 5,090 women who underwent radical hysterectomy by either minimally invasive (n=2181) or open (n=2909) approach. Between 2010 and 2015, the proportion of radical hysterectomies performed by RH-MIS increased from 42.7% to 70.3% of all cases. In contrast to prior reports, 5-year survival among RH-MIS patients was significantly better compared to RH-open patients (92.5% vs. 90.8%, p=0.02). However, women who underwent RH-MIS were significant younger (45.6±12.3 v. 46.8±12.3 years, p&lt;0.001), more educated (p&lt;0.001), more likely to be White Non-Hispanic (p&lt;0.001) and diagnosed with earlier stage disease (p&lt;0.008). Women who underwent RH-MIS were also less likely to have positive surgical margins (2.2% v 3.5%, p=0.006). After accounting for these differences, there was no statistically significant difference in survival for women undergoing RH-MIS vs. RH-open (HR, 1.18; 95% CI: (0.96-1.45). Positive margin status was associated with worse survival only at low-volume hospitals (HR, 2.30; 95% CI: 1.09-11.31). However, no other association between hospital volume, surgical route, margin status and survival was observed. Curiously, survival for women diagnosed in 2012 (HR, 1.51; 95% CI, 1.05 – 2.17) and 2013 (HR, 1.49; 95% CI, 1.03-2.15) not other years was significantly worse when compared to 2015, regardless of surgical route. Conclusions: Positive surgical margins following radical hysterectomy appear to be most effectively addressed at high volume centers caring for women with cervical cancer. These observations underscore a national need for equitable access to radiation care for women being treated for early stage cervical cancer.

Association between patient volume to cardiologist, process of care, and clinical outcomes in heart failure.

The impact of hospital volume on clinical performance has been investigated by many researchers to date and thought that it is associated with quality of care and outcome for patients with heart failure (HF). This study sought to determine whether annual admissions of HF per cardiologist are associated with process of care, mortality, and readmission. Among the nationwide registry 'Japanese registry of all cardiac and vascular diseases - diagnostics procedure combination' data collected from 2012 to 2019, a total of 1127113 adult patients with HF and 1046 hospitals were included in the study. Primary outcome was in-hospital mortality, and secondary outcome was 30day in-hospital mortality and readmission at 30days and 6months. Hospital and patient characteristics and process of care measures were also assessed. Mixed-effect logistic regression and Cox proportional-hazards model was used for multivariable analysis, and adjusted odds ratio and hazard ratio were evaluated. Process of care measures had inverse trends for annual admissions of HF per cardiologist (P<0.01 for all measures: prescription rate of beta-blocker, angiotensin converting enzyme inhibitor or angiotensin II receptor blocker, mineralocorticoid receptor antagonist, and anticoagulant for atrial fibrillation). Adjusted odds ratio for in-hospital mortality was 1.04 (95% confidence interval (CI): 1.04-1.08, P=0.04) and 30day in-hospital mortality was 1.05 (95% CI: 1.01-1.09, P=0.01) for interval of 50 annual admissions of HF per cardiologist. Adjusted hazard ratio for 30day readmission was 1.05 (95% CI: 1.02-1.08, P<0.01) and 6month readmission was 1.07 (95% CI: 1.03-1.11, P<0.01). Plots of the adjusted odds indicated 300 as the threshold of annual admissions of HF per cardiologist for substantial increase of in-hospital mortality risk. Our findings demonstrated that annual admissions of HF per cardiologist are associated with worse process of care, mortality, and readmission with the threshold for mortality risk increased, emphasizing the optimal proportion of patients admitted with HF to cardiologist for better clinical performance.

The impact of hospital volume on the outcomes of minimally invasive hepatectomy for HCC

Background: Volume-outcome effects in healthcare have been previously reported, including in hepato-pancreato-biliary surgery. However, the definition of high-volume care for minimally invasive hepatectomy (MIH) for hepatocellular carcinoma (HCC) remains unclear. We sought to define the impact of MIH hospital volume associated with better short- and long-term survival outcomes among patients with HCC.

The impact of hospital volume on survival in patients with locally advanced colonic cancer.

High hospital volume has been shown associated with improved survival in patients with several cancers. The aim of this nationwide cohort study was to investigate whether hospital volume affects survival in patients with locally advanced colonic cancer. All patients with non-metastatic locally advanced colonic cancer diagnosed between 2007 and 2017 in Sweden were included. Tertiles of annual hospital volume of locally advanced colonic cancer were analysed and 5-year overall and colonic cancer-specific survival were calculated with the Kaplan-Meier method. HRs comparing all-cause and colonic cancer-specific mortality rates were estimated using Cox models adjusted for potential confounders (age, sex, year of diagnosis, co-morbidity, elective/emergency resection, and university hospital) and mediators (preoperative multidisciplinary team assessment, neoadjuvant chemotherapy, radical resection, and surgical experience). A total of 5241 patients were included with a mean follow-up of 2.7-2.8 years for low- and high-volume hospitals. The number of patients older than 79 years were 569 (32.3 per cent), 495 (29.9 per cent), and 482 (26.4 per cent) for low-, medium- and high-volume hospitals respectively. The 3-year overall survival was 68 per cent, 60 per cent and 58 per cent for high-, medium- and low-volume hospitals, respectively (P < 0.001 from log rank test). High volume hospitals were associated with reduced all-cause and colon cancer-specific mortality after adjustments for potential confounders (HR 0.76, 95 per cent CI 0.62 to 0.93 and HR 0.73, 95 per cent CI 0.59 to 0.91, respectively). The effect remained after inclusion of potential mediators. High hospital volume is associated with reduced mortality in patients with locally advanced colonic cancer.

Impact of hospital volume on people with disability and outcomes for cancer surgery

BackgroundThis study was performed to examine the association between hospital volume and mortality in people with disability. MethodsA retrospective cohort study was conducted using a data set linking the Korean National Health Service database, disability registration data, and Korean Central Cancer Registry data. Data was gathered from all patients undergoing the four major surgical procedures for cancer care during an 11-year period from 2003 to 2013. ResultsFor all procedures, patients with disability were more likely to visit low-volume hospitals compared with those without disability. The 30-day mortality rate after each type of surgery at low-surgery-volume hospitals was higher in patients with disability; especially, the mortality rates after colectomy were 1.1% for patients without disabilities and 2.6% for patients severely disabilities. In univariate logistic regression analyses, patients with disability, especially those with severe or intellectual/psychological disabilities, were significantly less likely to undergo treatment at a high-volume hospital compared with patients without disability. In contrast, multiple logistic regression analysis indicated that patients with disability were significantly more likely to undergo gastrectomy (OR 3.76, 95% CI 1.64–8.58), colectomy (OR 3.08, 95% CI 1.46–6.48), and mastectomy (OR 3.92, 95% CI 1.25–12.33) at a high-volume hospital compared with patients without disability. ConclusionPublic health policies should focus on patients with disability to reduce health disparities and educate health care professionals, as well as the patients and their families, to alleviate negative perceptions about the need for equal diagnosis and treatment.

Impact of Hospital Volume on Utilization of Minimally Invasive Surgery for Gastric Cancer.

Minimally invasive surgery (MIS) for gastric cancer is increasingly performed. The purpose of this study is to evaluate trends in utilization of laparoscopic and robotic techniques compared to open surgery as well as utilization based on hospital volume. We used the National Cancer Database to query patients who underwent gastrectomy from 2010 to 2017 for adenocarcinoma. Regression analyses were used to determine associations between MIS and clinical factors, the trend of MIS over time, and survival. A total of 18,380 patients met inclusion criteria. The annual rates of MIS increased for all hospital volumes, though lower volume centers were less likely to undergo MIS. MIS was associated with a shorter length of stay compared to open, and robotic gastrectomy had a higher rate of obtaining at least 15 lymph nodes and lower rate of having a positive margin. MIS utilization for resection of gastric cancer increased over time, with robotic surgery increasing at a higher rate than laparoscopic surgery. Importantly, this occurred without increased in mortality or sacrificing adequate oncologic outcomes.

Volume Improves Outcomes in Septal Myectomy, but Who Gets Left Behind?

The study by Holst and colleagues 1 Holst K.A. Schaff H.V. Smedira N.G. et al. Impact of hospital volume on outcomes of septal myectomy for hypertrophic cardiomyopathy. Ann Thorac Surg. 2022; 114: 2131-2139https://doi.org/10.1016/j.athoracsur.2022.05.062 Abstract Full Text Full Text PDF Scopus (2) Google Scholar in this issue of The Annals of Thoracic Surgery adds septal myectomy for hypertrophic cardiomyopathy to a well-established and growing list of specialized cardiothoracic surgical procedures where the “best” results are obtained in high-volume reference centers . For the authors—themselves largely from such high-volume centers—the results probably tell them what they know and reinforces their practice. Impact of Hospital Volume on Outcomes of Septal Myectomy for Hypertrophic CardiomyopathyThe Annals of Thoracic SurgeryVol. 114Issue 6PreviewLeft ventricular outflow tract obstruction is common among symptomatic patients with hypertrophic cardiomyopathy, yet septal reduction by surgical myectomy (septal myectomy [SM]) is performed infrequently in many centers. This study examined the possible relationship between institutional case volume and early outcomes of SM. Full-Text PDF

Impact of Hospital Volume on Outcomes of Septal Myectomy for Hypertrophic Cardiomyopathy

BackgroundLeft ventricular outflow tract obstruction is common among symptomatic patients with hypertrophic cardiomyopathy, yet septal reduction by surgical myectomy (septal myectomy [SM]) is performed infrequently in many centers. This study examined the possible relationship between institutional case volume and early outcomes of SM. MethodsThe Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for patients with hypertrophic cardiomyopathy who underwent SM from January 2012 to December 2019. The study defined center case volume categories as <1, 1 to 4.99, 5 to 9.99, and ≥10 cases performed on average per year. ResultsThe study population included 5935 patients at 481 centers with 933 surgeons. The range of average center volume was <1 to 138 cases per year. Overall early mortality was 2.6%, ventricular septal defect (VSD) occurred in 1.9%, and complete heart block occurred in 9.0%. Concomitant mitral valve (MV) repair was performed in 28.7%, and MV replacement was performed in 17.1%. In multivariable analysis, the lowest annual case volume (average <1 case/y) was consistently associated with greater early mortality (odds ratio [OR], 5.4; CI, 3.0-9.9; P < .001), greater risk of VSD (OR, 9.3; CI ,4.2-20.4; P < .001), increased incidence of complete heart block (OR, 2.0; CI, 1.5-2.7; P < .001), and a higher likelihood of MV replacement (OR, 9.4; CI, 7.5-11.8; P < .001). ConclusionsVolume of SM cases varies widely among institutions reporting to the Society of Thoracic Surgeons Adult Cardiac Surgery Database. There appears to be an important association between surgical experience, as reflected by institutional case volume, and early outcomes, including mortality, as well as the occurrence of VSD, heart block, and MV replacement.

Does hospital volume affect outcomes after abdominal cancer surgery: an analysis of Swiss health insurance claims data

BackgroundMedical treatment quality has been shown to be better in high volume than in low volume hospitals. However, this relationship has not yet been confirmed in abdominal cancer in Switzerland and is relevant for referral of patients and healthcare planning. Thus, the present study investigates the association between hospital volumes for surgical resections of colon, gastric, rectal, and pancreatic carcinomas and outcomes.MethodsThis retrospective analysis is based on anonymized claims data of patients with mandatory health insurance at Helsana Group, a leading health insurance in Switzerland. Outcome parameters were length of hospital stay, mortality and cost during the inpatient stay as well as at 1-year follow-up. Hospital volume information was derived from the Quality Indicators dataset provided by the Swiss Federal Office of Public Health. The impact of hospital volume on the different treatment outcomes was statistically tested using generalized estimating equations (GEE) models, taking into account the non-independence of observations from the same hospital.ResultsThe studies included 2′859 resections in patients aged 18 years and older who were hospitalized for abdominal cancer surgery between 2014 and 2018. Colon resections were the most common procedures (n = 1′690), followed by rectal resections (n = 709). For rectal, colon and pancreatic resections, an increase in the mean number of interventions per hospital and a reduction of low volume hospitals could be observed. For the relationship between hospital volume and outcomes, we did not observe a clear dose-response relationship, as no significantly better outcomes were observed in the higher-volume category than in the lower-volume category. Even though a positive “routine effect” cannot be excluded, our results suggest that even hospitals with low volumes are able to achieve comparable treatment outcomes to larger hospitals.ConclusionIn summary, this study increases transparency on the relationship between hospital volume and treatment success. It shows that simple measures such as defining a minimum number of procedures only might not lead to the intended effects if other factors such as infrastructure, the operating team or aggregation level of the available data are not taken into account.

A0973 - Impact of hospital volume on the outcomes of renal trauma management

A0973 - Impact of hospital volume on the outcomes of renal trauma management

Impact of hospital volume of valve operations on the utilization and outcomes of surgery for patients with infective endocarditis

Valve surgery is indicated and can be life-saving in patients with infective endocarditis (IE). We evaluated the impact of hospital valvular surgery volume on utilization and outcomes of surgery for IE. National Inpatient Sample (NIS) database was used for IE hospitalizations from 2008 to 2015. Hospitals were divided into quartiles based on valve surgery volume with quartile 1 (Q1) indicating lowest volume and quartile 4 (Q4) highest volume. Primary outcome was utilization of valve surgery in patients hospitalized with IE and secondary outcomes were in-hospital mortality and length of stay for IE patients undergoing valve surgery. Volume-outcome relationship was analysed both as categorical (quartiles) and continuous variable (restricted cubic splines). A total of 36 471 hospitalizations for IE were identified using the NIS database from 2008 to 2015 of which 17.33% underwent any valve surgery. Utilization rates of valve surgery for IE were significantly higher in Q4 hospitals (Q1: 6.73%; Q2: 10.39%; Q3: 14.91%; Q4: 2321%). Amongst the admissions for IE endocarditis undergoing valve surgery, there was no significant difference in in-hospital mortality when analysed as a categorical variable (as quartiles). However, when analysed as a continuous variable we note significant variation in outcomes across the Q4 hospitals, with highest volume centres having reduced mortality rates and length of stay. Hospital valvular surgery volume has direct impact on utilization and outcomes of surgery for IE. Given rising rates of IE and ongoing intravenous drug pandemic, there is need for regionalization of care for IE patients and development of 'endocarditis centres of excellence' for improved patient outcomes.

The impact of hospital volume on racial disparities in resected rectal cancer.

Althoughhigh volume centers (HVC) equate to improved outcomes in rectal cancer, the impact of surgical volume related to race is less defined. Patients who underwent surgical resection for stage I-III rectal adenocarcinoma were divided into cohorts based on race and hospital surgical volume. Outcomes were analyzed following 1:1 propensity-score matching using logistic, Poisson, and Cox regression analyses with marginal effects. Fifty-four thousand one hundred and eighty-four (91.5%) non-Black and 5043 (8.5%) Black patients underwent resection of rectal cancer. Following 1:1 matching of non-Black (N = 5026) and Black patients, 5-year overall survival (OS) of Black patients was worse (72% vs. 74.4%, average marginal effects [AME] 0.66, p = 0.04) than non-Black patients. When compared to non-Black patients managed at HVCs, Black patients had worse OS (70.1% vs. 74.7%, AME 1.55, p = 0.03), but this difference was not significant when comparing OS between non-Black and Black patients managed at HVCs (72.3% vs. 74.7%, AME 0.62, p = 0.06). Length of stay was longer among Black and HVC patients across all cohorts. There was no difference across cohorts in 90-day mortality. Althoughracial disparities exist in rectal cancer, this disparity appears to be ameliorated when patients are managed at HVCs.

Postoperative morbidity and mortality after surgical resection of small bowel neuroendocrine neoplasms: A systematic review and meta-analysis.

Although small bowel resection is generally considered a low risk gastrointestinal procedure, this might not be true for small bowel neuroendocrine neoplasms (SB‐NEN) as a result of potential central mesenteric involvement. We aimed to determine the reported morbidity and mortality after resection of SB‐NEN in the literature and assess the effect of hospital volume on postoperative morbidity and mortality. A systematic review was performed by searching MEDLINE and Embase in March 2021. All studies reporting morbidity and/or mortality after SB‐NEN resection were included. Pooled proportions of overall morbidity (Clavien‐Dindo I‐IV), severe morbidity (Clavien‐Dindo III‐IV), 30‐day mortality, 90‐day mortality and in‐hospital mortality were calculated, as well as the association with hospital volume (high volume defined as the fourth quartile). Thirteen studies were included, with a total of 1087 patients. Pooled proportions revealed an overall morbidity of 13% (95% confidence interval [CI] = 7%‐24%, I 2 = 90%), severe morbidity of 7% (95% CI = 4%‐14%, I 2 = 70%), 30‐day mortality of 2% (95% CI = 1%‐3%, I 2 = 0%), 90‐day mortality of2% (95% CI = 2%‐4%, I 2 = 35%) and in‐hospital mortality of 1% (95% CI = 0%‐2%, I 2 = 0%). An annual hospital volume of nine or more resections was associated with lower overall and severe morbidity compared to lower volume: 10% vs 15% and 4% vs 9%, respectively. Thirty‐day mortality was similar (2% vs 1%) and 90‐day mortality was higher in high‐volume hospitals: 4% vs 1%. This systematic review with meta‐analyses showed severe morbidity of 7% and low mortality rates after resection of SB‐NEN. The currently available literature suggests a certain impact of hospital volume on postoperative outcomes, although heterogeneity among the included studies constrains interpretation.

Impact of Hospital Volume on Outcome After Surgical Treatment for Hydrocephalus: A U.S. Population Study From the National Inpatient Sample.

IntroductionHydrocephalus remains a common condition with significant patient morbidity; however, accurate accounting of the incidence of this disease as well as of the impact of hospital volume on outcome remains limited.MethodsThe National Inpatient Sample was used to evaluate patients who underwent surgical treatment of hydrocephalus from 2009-2013. Patient demographics (e.g., length of stay, disposition, charges), and the impact of hospital volume on outcomes were evaluated.ResultsA total of 156,205 patients were identified. Ventriculoperitoneal (VP) shunting the most common type of device (35.8%) followed by shunt replacement (23.9%). Treatment charges for hydrocephalus were $332 million in 2009 and $418 million in 2013 nationally. High-volume hospitals had more routine discharges compared with lower-volume hospitals (65.7% vs. 50.9%, p<0.0001), which was a trend that improved over time. Multivariate analysis confirmed that hospital volume was independently associated with routine disposition after adjusting for other factors such as patient age, length of stay, and shunt type. However, hospital volume showed a small association with length of stay (β = -0.05, p = 0.0001) and did not impact hospital charges on multivariate analysis.ConclusionThis analysis provides a recent update of hydrocephalus epidemiology, trends, and outcomes nationally. Estimates from this study suggest that hydrocephalus is a common and costly problem. Hospital volume was for the first time to be associated with important differences in patient outcomes.

Impact of hospital volume on hepatocellular carcinoma survival in Italy

Introduction: Scanty data are available about the impact of hospital volume on the survival of hepatocellular carcinoma (HCC) patients.

Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure

BackgroundHospital volume is known to be associated with outcomes of patients requiring complicated medical care. However, the relationship between hospital volume and prognosis of hospitalized patients with heart failure (HF) remains not fully understood. We aimed to clarify the impact of hospital volume on clinical outcomes of hospitalized HF patients using a nationwide inpatient database.Methods and resultsWe studied 447,818 hospitalized HF patients who were admitted from January 2010 and discharged until March 2018 included in the Japanese Diagnosis Procedure Combination database. According to the number of patients, patients were categorized into three groups; those treated in low-, medium-, and high-volume centers. The median age was 81 years and 238,192 patients (53%) were men. Patients who had New York Heart Association class IV symptom and requiring inotropic agent within two days were more common in high volume centers than in low volume centers. Respiratory support, hemodialysis, and intra-aortic balloon pumping were more frequently performed in high volume centers. As a result, length of hospital stay was shorter, and in-hospital mortality was lower in high volume centers. Lower in-hospital mortality was associated with higher hospital volume. Multivariable logistic regression analysis fitted with generalized estimating equation indicated that medium-volume group (Odds ratio 0.91, p = 0.035) and high-volume group (Odds ratio 0.86, p = 0.004) had lower in-hospital mortality compared to the low-volume group. Subgroup analysis showed that this association between hospital volume and in-hospital mortality among overall population was seen in all subgroups according to age, presence of chronic renal failure, and New York Heart Association class.ConclusionHospital volume was independently associated with ameliorated clinical outcomes of hospitalized patients with HF.