Impact Of Hospital Volume Research Articles

The Impact of Hospital Volume and Charlson Score on Postoperative Mortality of Proctectomy for Rectal Cancer: A Nationwide Study of 45,569 Patients.

To identify the impact of hospital volume according to Charlson Comorbidity Index (ChCI) on postoperative mortality (POM) after rectal cancer surgery. A volume-outcome relationship has been established in complex surgical procedures. However, little is known regarding the impact of hospital volume on POM according to patients' comorbidities after rectal cancer surgery. All patients undergoing proctectomy for cancer from 2012 to 2016 were identified in the French nationwide database. Patient condition was assessed on the basis of the validated ChCl and was stratified into 3 groups according to the score (0-2, 3, and ≥4). Chi-square automatic interaction detector (CHAID) was used to identify the cut-off values of the annual proctectomy caseload affecting the 90-day POM. The 90-day POM was analyzed according to hospital volume (low: <10, intermediate: 10-40, and high: ≥41 cases/yr) and ChCI. Among 45,569 rectal cancer resections, the 90-day POM was 3.5% and correlated to ChCI (ChCI 0-2: 1.9%, ChCI 3: 4.9%, ChCI ≥4: 5.8%; P < 0.001). There was a linear decrease in POM with increasing hospital volume (low: 5.6%, intermediate: 3.5%, high: 1.9%; P < 0.001). For low-risk patients (ChCl 0-2), 90-day POM was significantly higher in low and intermediate hospital volume compared with high hospital volume centers (3.2% and 1.8% vs 1.1%; P < 0.001). A significant decrease in postoperative hemorrhage complication rates was observed with increasing center volume (low: 13.3%, intermediate: 11.9%, and high: 9.4%; P < 0.001). After multivariable analysis, proctectomy in low [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.71-2.58, P < 0.001] and intermediate (OR 1.45, 95% CI 1.2-1.75, P < 0.001) hospital volume centers were independently associated with higher risk of mortality. The POM after proctectomy for rectal cancer is strongly associated with hospital volume independent of patients' comorbidities. To improve postoperative outcomes, rectal surgery should be centralized.

Extracorporeal membrane oxygenation in Korea – Trends and impact of hospital volume on outcome: Analysis of national insurance data 2009–2014

PurposeECMO use has increased lately. However, differences between adult ECMO and non-ECMO patients admitted to the ICU remain unstudied. In terms of volume-outcome relationship, the impact of ECMO volume on survival has not been validated in a real world cohort. Materials and methodsRetrospective analysis of data from the Korean Health Insurance Review and Assessment Service over 5 years, between August 1, 2009 and July 31, 2014. The ECMO group comprised patients who received ≥1 ECMO run. Data on patient demographics, ICU and hospital length of stay, cost, treatments, and in-hospital mortality were collected. Usage trends were analyzed by 5 one-year periods. ResultsAmong 1, 265, 508 ICU patients, 6078 underwent ECMO during the study period. The number of ECMO patients rose by 2.5 times, and ECMO hospitals from 50 to 86 between periods 1 and 5. Compared to non-ECMO patients, the ECMO group was younger (59 years vs. 64 years, p < .0001) with more comorbidities. Healthcare expenditure and in-hospital mortality in the ECMO group were higher (US $23,600 vs. $5100; 63.4% vs. 12.6%; p < .0001). Using multivariable analysis, age ≥ 50 years, CRRT, and annual hospital ECMO volume < 20 negatively impacted survival to discharge. ConclusionThe prevalence of ECMO among ICU patients was 0.5%. The expenditure and in-hospital mortality of the ECMO group were four and five times higher than non-ECMO group respectively. An annual hospital ECMO volume ≥ 20 may improve survival to hospital discharge.

Impact of Hospital Volume on Mortality in Patients With Liver Cirrhosis Undergoing Coronary Artery Bypass Graft Surgery: A National Analysis

Impact of Hospital Volume on Mortality in Patients With Liver Cirrhosis Undergoing Coronary Artery Bypass Graft Surgery: A National Analysis

The impact of hospital volume on clinical and economic outcomes in ventral hernia repair: an analysis with national policy implications.

The objectives of this study are to evaluate the associations between ventral hernia repair procedure volume and patient outcomes, including both clinical and economic outcomes. The 2014 National Inpatient Sample was queried for patients who underwent elective, open ventral (incisional) hernia repair with or without mesh. Outcomes included occurrence of major or wound-based in-hospital complications, extended length of stay (> 4days), and increased costs (> $12,816). High-volume hospitals were defined as the 90th percentile of case volume or higher (> 60cases/year). Multivariate regression was performed to access the outcomes associated with high-volume hospitals. 54,075 patients at 2049 hospitals were retrieved. 41.4 percent of patients were treated at high-volume hospitals. Patients treated at high-volume hospitals were less likely to experience a major complication (OR 0.88; 95% CI 0.82-0.96; p = 0.002) or wound-based complication (OR 0.84; 95% CI 0.76-0.92; p < 0.001). However, in terms of resource utilization, patients treated at high-volume hospitals were more likely to experience an extended length of stay (OR 1.14; 95% CI 1.09-1.12; p < 0.001) and an increase in costs (OR 1.23; 95% CI 1.17-1.29; p < 0.001). Hospitals that perform a larger number of ventral hernia repairs, despite caring for a more complex patient population, may be associated with better patient outcomes than lower volume hospitals. However, these same high-volume centers demonstrate an extended length of stay and increased costs. Further research is needed to understand the reason for this gap in proper resource utilization in high-volume ventral hernia repair centers.

Impact of hospital volume on patterns of care and outcomes in soft tissue sarcoma.

e23550Background: Given the rarity and nuance of soft-tissue sarcoma management, current clinical guidelines call for treatment at experienced treatment facilities. However, the actual impact of sa...

Mo1182 - Impact of Hospital Volume on Mortality, Treatment Metrics and Resource Utilization Among Patients with Non-Variceal Upper Gastrointestinal Hemorrhage in the United States

Mo1182 - Impact of Hospital Volume on Mortality, Treatment Metrics and Resource Utilization Among Patients with Non-Variceal Upper Gastrointestinal Hemorrhage in the United States

Impact of hospital volume on racial disparities and outcomes for endometrial cancer

ObjectiveLittle is known about the influence of hospital procedural volume on racial disparities for uterine cancer. We examined whether the magnitude of the survival differential between black and white women varied based on hospital procedural volume for endometrial cancer. MethodsWe utilized the National Cancer Data Base to examine women with endometrial cancer from 1998 to 2012. Annualized hospital procedural volume was calculated and hospitals grouped into volume-based quartiles. Multivariable models were developed to examine differences in two and five-year survival between black and white women across the hospital volume categories. Patients were classified as early or advanced stage and as type I (low grade, endometrioid) or type II (high grade endometrioid, other histologies) cancers. ResultsWe identified 243,422 (75.0%) white and 27,764 (8.6%) black women treated at 1059 hospitals. Regardless of hospital volume, black women had decreased survival. For each tumor class, the absolute difference in adjusted two-year survival between black and white women decreased with increasing hospital volume. For example, for women with early-stage, type I tumors, the adjusted two-year survival differential between blacks and whites was −1.4% (95%CI, −2.4 to −0.5%) at low volume centers and decreased to −0.5% (95%CI, −0.9 to 0%) at high-volume hospitals (P<0.0001). For advanced stage, type I tumors, the adjusted survival differential decreased from −12.4% (95%CI, −24.0 to −0.9%) to 1.2% (95%CI, −2.9 to 5.3%) at high volume hospitals (P<0.0001). ConclusionBlack race is an independent predictor of mortality. The impact of race on mortality is mitigated, albeit not eliminated, by increasing hospital volume.

Use of the THERMOCOOL SMARTTOUCH catheter for ablation of atrial fibrillation: the relationship between hospital procedure volume, re-admissions, and economic outcomes

Objective: The purpose of this study was to examine the relationship between hospital volume of prior THERMOCOOL SMARTTOUCH catheter use and health and economic outcomes among hospitalized patients with atrial fibrillation (AF) undergoing ablation using this device.Materials and methods: Patients aged ≥18 years with a primary diagnosis of AF undergoing ablation treatment using the THERMOCOOL SMARTTOUCH catheter between January 2014 and June 2016 were identified from the Premier hospital database with the first date of such a procedure being defined as the index date. Hospital volume of prior THERMOCOOL SMARTTOUCH catheter use was determined during the 12-month pre-index period, and was classified into five groups: no volume (0), low volume (1–50), mid volume (51–100), high volume (101–150), and very high volume (≥151). Outcomes, including length of stay (LOS; for inpatient procedure only), hospital costs (total, hospital pharmacy, supply), and all-cause re-admission were evaluated. A generalized estimating equation (GEE) with exchangeable correlation structure was used to examine the impact of hospital volume on LOS, hospital costs, and re-admissions controlling for hospital clustering and other covariates.Results: The study population included 640 hospitalized AF patients. The adjusted mean LOS was significantly shorter in very high-volume hospitals than hospitals with no volume (mean LOS 2.30 vs 4.33 days; p = .0377). As volume increased, the mean adjusted supply cost tended to decrease, although these changes emerged as non-significant. The 12-month all-cause re-admission was significantly lower among patients undergoing ablation in low (Odds ratio [OR] = 0.27; confidence interval [CI] = 0.08–0.85) and mid (OR = 0.12; CI = 0.02–0.61) volume hospitals compared to hospitals with no volume.Limitations: Study results may not be generalizable to all US hospitals.Conclusions: Among AF patients undergoing ablation, increased hospital volume of prior THERMOCOOL SMARTTOUCH catheter use was associated with shorter LOS and a lower likelihood of all-cause re-admission.

Impact of Hospital Volume on Long-Term Neurological Outcome in Patients Undergoing Carotid Artery Stenting: A Nationwide Propensity Score-Matched Study. DOI: 10.1002/ccd.26989.

Impact of Hospital Volume on Long-Term Neurological Outcome in Patients Undergoing Carotid Artery Stenting: A Nationwide Propensity Score-Matched Study. DOI: 10.1002/ccd.26989.

Impact of hospital volume on mortality in patients with severe torso injury

BackgroundWhether a positive volume-outcome relationship exists in the context of trauma remains controversial. Heterogeneity in the definition of hospital volume in previous studies is one of the main reasons for this inconclusiveness. We investigated whether hospital volume is associated with mortality in patients with severe torso injury using two different definitions of hospital volume. Materials and methodsThis retrospective cohort study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to tertiary emergency centers with severe torso injury and underwent emergency surgery or interventional radiology treatment for the torso injury upon admission from April 1, 2010 to March 31, 2014 were included. Hospital volume was defined as the annual number of admissions with severe torso injury (HV-torso) or the annual number of total trauma admissions (HV-all). The main outcome was 28-d mortality. Multivariable logistic regression models fitted with generalized estimating equations were used to evaluate relationships between hospital volume and 28-d mortality. ResultsOverall, 7725 patients were included. The 28-d mortality rate was 15.3%. The HV-torso was significantly associated with reduced 28-d mortality (adjusted odds ratio = 0.59; 95% confidence interval = 0.44-0.79). However, there was no significant association between the HV-all and mortality (adjusted odds ratio = 1.02; 95% confidence interval = 0.72-1.46). ConclusionsThe HV-torso was significantly associated with reduced mortality in patients with severe torso injury. In contrast, the HV-all had no significant relationship with their mortality. Regionalization of trauma care for severe torso injury may be beneficial for patients with severe torso injury.

543 The Impact of Hospital Volume and Endoscopist’s Experience on the Outcome of Endoscopic Retrograde Cholangiopancreatography; a Prospective Multicenter Observational Study

543 The Impact of Hospital Volume and Endoscopist’s Experience on the Outcome of Endoscopic Retrograde Cholangiopancreatography; a Prospective Multicenter Observational Study

Impact of hospital volume on patient outcome post pancreaticoduodenectomy in two different eras, a single institutional experience

Impact of hospital volume on patient outcome post pancreaticoduodenectomy in two different eras, a single institutional experience

Impact of hospital volume on outcomes for laparoscopic adhesiolysis for small bowel obstruction

BackgroundVolume-to-outcome data have been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of institutional procedural volume on length of stay (LOS), outcomes, and costs in LLOA for SBOs. Materials and methodsThe Nationwide Inpatient Sample data set between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the period, and high-volume hospitals were designated as those performing greater than five LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. LOS, total charges, and costs were reported as means with standard deviation and median values. P < 0.05 was considered significant. ResultsA total of 9111 discharges were selected, which was representative of 43,567 weighted discharges nationally between 2000 and 2013. Over the study period, there has been a 450% increase in the number of LLOA performed. High-volume hospitals had significantly shorter LOS (mean: 4.92 ± standard error (SE) 0.13 d; median: 3.6) compared to low-volume hospitals (mean: 5.68 ± 0.06 d; median: 4.5). In multivariate analysis, high-volume status was associated with a decreased LOS of 0.72 d (P < 0.0001) as compared to low-volume status. Other significant predictors for decreased LOS included decreased age, decreased comorbidity, and the absence of small bowel resection. There was no significant association between volume status and total charges in multivariate or univariate models, but high-volume hospitals were associated with lower costs in multivariate models by approximately $984 (P = 0.017). ConclusionsThis study demonstrates that high hospital volume was associated with decreased LOS for LLOA in SBO. Although volume was not associated with differences in total charges, there was a small decrease in hospital costs.

653 - Impact of hospital volume and surgeon volume on robot-assisted partial nephrectomy results: A multicenter study

653 - Impact of hospital volume and surgeon volume on robot-assisted partial nephrectomy results: A multicenter study

Does Higher Volume Lead to Higher Performance? The Impact of Hospital Volume on 90-Day Postoperative Outcomes after Pancreaticoduodenectomy

Kagedan, Daniel J. MD; Goyert, Nik; Li, Qing; Paszat, Lawrence MD; Kiss, Alexander PhD; Earle, Craig C. MD; Karanicolas, Paul J. MD, PhD; Wei, Alice C. MD, FRCSC, FACS; Mittmann, Nicole PhD; Coburn, Natalie G. MD, MPH, FACS Author Information

Impact of hospital volume on risk-adjusted mortality following oesophagectomy in Japan.

Previous studies have reported that patients undergoing oesophagectomy in high-volume hospitals experience lower mortality rates. However, there has been ongoing discussion regarding the validity of evidence for this association. The purpose of this study was to investigate the relationship between hospital volume and risk-adjusted mortality following oesophagectomy in Japan, using a nationwide web-based database. The study included patients registered in the database as having undergone oesophagectomy with reconstruction between 2011 and 2013. Outcome measures were 30-day and operative mortality rates. Logistic regression analysis was used to adjust for hospital volume, surgeon volume and risk factors for mortality after oesophagectomy. A total of 16 556 oesophagectomies at 988 hospitals were included; the overall unadjusted 30-day and operative mortality rates were 1·1 and 3·0 per cent respectively. The unadjusted operative mortality rate in hospitals performing fewer than ten procedures per year (5·1 per cent) was more than three times higher than that in hospitals conducting 30 or more procedures annually (1·5 per cent). Multivariable models indicated that hospital volume had a significant effect on 30-day (odds ratio 0·88 per 10-patient increase; P = 0·012) and operative (odds ratio 0·86 per 10-patient increase; P < 0·001) mortality. In Japan, high-volume hospitals had lower risk-adjusted 30-day and operative mortality rates following oesophagectomy compared with low-volume hospitals.

Impact of hospital volume on quality indicators for rectal cancer surgery in British Columbia, Canada

BackgroundThe relationship between hospital volume and patient outcomes remains controversial for rectal cancer. MethodsThis is a population-based database study. Patients treated with surgery for a stage I to III rectal adenocarcinoma from 2003 to 2009 were identified. High-volume hospitals (HVH) were those centers performing 20 surgeries or more per year. Primary outcomes were operative and perioperative factors that have proven influence on patient outcomes. ResultsIn all, 2,081 patients had surgery for rectal cancer. Of these, 1,690 patients had surgery in an HVH and 391 had surgery in a low-volume hospital. On multivariate analysis, patients who had surgery in an HVH were more likely to have sphincter-preserving surgery, 12 or more lymph nodes removed with the tumor, neoadjuvant radiation therapy, and receive pre-operative or postoperative chemotherapy. ConclusionsFor rectal cancer patients in British Columbia, Canada, being treated at an HVH is associated with several quality indicators linked to better patient outcomes.

Impact of hospital volume on outcomes following treatment of thoracic aortic aneurysms and type-B dissections.

Previous research suggests an association between hospital volume and outcomes in high-risk surgical pathologies. The association between hospital volume and outcomes in patients with isolated descending thoracic aortic aneurysms (DTAAs) and type-B thoracic aortic dissections (TBADs) is conflicting. We aimed to investigate this in a literature review and meta-analysis. A systematic review of the literature was performed to identify studies reporting mortality and morbidity following repair (elective or emergency) of DTAA and/or TBAD using the Medline and Embase Databases (2000-2015). Hospital volume was assessed based on the number of patients treated per institution: low volume (1-5 cases per year), medium volume (6-10) and high volume (>10). The primary outcome of interest was all-cause mortality during inpatient stay and at 30 days. Eighty-four series of non-dissecting DTAA or TBAD were included in data synthesis (4219 patients; mean age: 62 years; males: 73.5%). For all patients (emergency and elective) undergoing DTAA repair, in-hospital mortality was 8% [95% confidence interval (CI): 6-8%]. Results were not superior in high-volume centres (8 vs 6 vs 11% for high-, medium- and low-volume, respectively). Sub-analyses for emergency and elective repairs showed no significant differences. For TBAD repairs, in the combined population (emergency and elective), results reached borderline significance (P = 0.0475), favouring high-volume centres (6 vs 11 vs 14%), but this association disappeared when emergency and elective repairs were analysed separately. Nine series reported outcomes at 1 year and 5 series followed DTAA and 18 TBAD treatment. No meaningful long-term comparisons were possible due to the lack of data. No significant associations were detected between hospital volume and subsequent mortality following DTAA or TBAD treatment. Data were heterogeneous and long-term results were scarcely reported. A well-designed longitudinal study of sufficient size is required to inform future strategies in this area.

Hospital volume and post-discharge mortality in Medicare beneficiaries aged 65 and older with acute leukemia.

6560Background: While the hospital volume-outcome relationship has been established for many complex surgeries and invasive procedures, the impact of hospital volume on outcomes for acute leukemia ...

Hospital Variability in Postoperative Mortality After Rectal Cancer Surgery in the Spanish Association of Surgeons Project: The Impact of Hospital Volume

ObjectiveThis multicentre observational study examines variation between hospitals in postoperative mortality after elective surgery in the Rectal Cancer Project of the Spanish Society of Surgeons and explores whether hospital volume and patient characteristics contribute to any variation between hospitals. MethodsHospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all rectal adenocarcinomas operated by an anterior resection or an abdominoperineal excision at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, tumour location and stage, administration of neoadjuvant treatment, and annual volume of surgical procedures. ResultsA total of 9809 consecutive patients were included. The rate of 30-day postoperative mortality was 1.8% Stratified by annual surgical volume hospitals varied from 1.4 to 2.0 in 30-day mortality. In the multilevel regression analysis, male gender (OR 1.623 [1.143; 2.348]; P<.008), increased age (OR: 5.811 [3.479; 10.087]; P<.001), and ASA score (OR 10.046 [3.390; 43.185]; P<.001) were associated with 30-day mortality. However, annual surgical volume was not associated with mortality (OR 1.309 [0.483; 4.238]; P=.619). Besides, there was a statistically significant variation in mortality between all departments (MOR 1.588 [1.293; 2.015]; P<.001). ConclusionPostoperative mortality varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume.