Impact of Hospital Case Volume on the Quality of Laparoscopic Colectomy in Japan

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

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WELL-PLANNED GREEN SPACES IMPROVE MEDICAL OUTCOMES, SATISFACTION AND QUALITY OF CARE: A TRUST HOSPITAL CASE STUDY

Acta Horticulturae ◽

10.17660/actahortic.2010.881.133 ◽

2010 ◽

pp. 813-818

Author(s):

A. Riaz ◽

A. Younis ◽

W. Ali ◽

M. Hameed

Keyword(s):

Quality Of Care ◽

Green Spaces ◽

Medical Outcomes ◽

Hospital Case ◽

Trust Hospital

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Abstract WP358: Comprehensive Integrated Stroke System: A Novel Approach to Optimizing Cerebrovascular Disease Care

Stroke ◽

10.1161/str.51.suppl_1.wp358 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Victor Lopez-Rivera ◽

Sunil A Sheth ◽

Sean I Savitz ◽

Songmi Lee ◽

James Fan ◽

...

Keyword(s):

Stroke Therapy ◽

Case Volume ◽

Quality Outcomes ◽

Good Outcome ◽

System A ◽

Time Sensitivity ◽

Novel Approach ◽

Distribution Of Resources ◽

Observational Cohort

Introduction: There is a need to deliver endovascular stroke therapy (EST) locally and rapidly, due to the time sensitivity of acute ischemic stroke (AIS). However, the optimal distribution of resources, and means to maintain quality outcomes in patients with diseases that benefit from concentrated care at specialized centers, including subarachnoid hemorrhage (SAH), is unknown. Methods: We performed a multicenter, observational cohort study across our 11-hospital network from Jan 2017 - Feb 2019, identifying AIS patients who received EST. From Jan 2017 - Aug 2017, there was one CSC in the system. Starting in Aug 2017, we implemented an Integrated Stroke System (ISS), in which 3 additional centers became CSCs, practices were standardized across a single physician group covering all 4 CSCs, and SAH care was centered at the original CSC, while EST was performed at 3 new CSCs. Logistic regression adjusted for age, sex, NIHSS, direct vs. transfer arrival, and time from onset to recanalization was used to assess likelihood of good outcome, defined as discharge to home or rehabilitation. Results are given as median [IQR] and OR [95% CI]. Results: Among 478 patients who received EST, median age was 68 [57-78], 47% were female, and 37% were white. Over the course of the study (Fig. 1), the number of monthly EST cases increased; EST volume at our original CSC remained stable, and an increasing EST was performed at the new CSCs (p<0.01). Monthly SAH case volume remained unchanged at the original CSC (29 cases vs. 30 cases, p=0.68). After implementation of our ISS, there was a decrease in the time from arrival to groin puncture (107 min [88-125] vs 92 min [67-120]; p<0.01). Among patients presenting 0-6 hours, there was a significant improvement in likelihood of good outcome after ISS (OR 2.59 [1.06-6.35]; p<0.05). Conclusions: By restructuring our stroke system of care and extending EST capability, we observed increased EST utilization and improvement in quality of care for AIS patients.

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Improving Quality of Surgical Care and Outcomes: Factors Impacting Surgical Site Infection after Colorectal Resection

The American Surgeon ◽

10.1177/000313481408000823 ◽

2014 ◽

Vol 80 (8) ◽

pp. 759-763 ◽

Cited By ~ 5

Author(s):

Virginia Oliva Shaffer ◽

Caitlin D. Baptiste ◽

Yuan Liu ◽

Jahnavi K. Srinivasan ◽

John R. Galloway ◽

...

Keyword(s):

Risk Factors ◽

Glucose Level ◽

Univariate Analysis ◽

Significant Risk ◽

Surgical Care ◽

Surgical Site Infections ◽

Case Volume ◽

Improvement Project ◽

Combining Data

Surgical site infections (SSIs) result in patient morbidity and increased costs. The purpose of this study was to determine reasons underlying SSI to enable interventions addressing identified factors. Combining data from the American College of Surgeons National Surgical Quality Improvement Project with medical record extraction, we evaluated 365 patients who underwent colon resection from January 2009 to December 2012 at a single institution. Of the 365 patients, 84 (23%) developed SSI. On univariate analysis, significant risk factors included disseminated cancer, ileostomy, patient temperature less than 36°C for greater than 60 minutes, and higher glucose level. The median number of cases per surgeon was 36, and a case volume below the median was associated with a higher risk of SSI. On multivariate analysis, significant risks associated with SSI included disseminated cancer (odds ratio [OR], 4.31; P < .001); surgery performed by a surgeon with less than 36 cases (OR, 2.19; P = .008); higher glucose level (OR, 1.06; P 5.017); and transfusion of five units or more of blood (OR, 3.26; P 5.029). In this study we found both modifiable and unmodifiable factors associated with increased SSI. Identifying modifiable risk factors enables targeting specific areas to improve the quality of care and patient outcomes.

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