Impact of hospital case volume on testicular cancer outcomes and practice patterns

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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Percutaneous Coronary Intervention Operator Profiles and Associations With In-Hospital Mortality

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.121.010909 ◽

2021 ◽

Author(s):

Jacob A. Doll ◽

Adam J. Nelson ◽

Lisa A. Kaltenbach ◽

Daniel Wojdyla ◽

Stephen W. Waldo ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Hospital Mortality ◽

Patient Outcomes ◽

Clustering Algorithm ◽

Practice Patterns ◽

Coronary Intervention ◽

Case Mix ◽

Case Volume ◽

Percutaneous Coronary ◽

Cluster 2

Background: Percutaneous coronary intervention is performed by operators with differing experience, technique, and case mix. It is unknown if operator practice patterns impact patient outcomes. We sought to determine if a cluster algorithm can identify distinct profiles of percutaneous coronary intervention operators and if these profiles are associated with patient outcomes. Methods: Operators performing at least 25 annual procedures between 2014 and 2018 were clustered using an agglomerative hierarchical clustering algorithm. Risk-adjusted in-hospital mortality was compared between clusters. Results: We identified 4 practice profiles among 7706 operators performing 2 937 419 procedures. Cluster 1 (n=3345) demonstrated case mix and practice patterns similar to the national median. Cluster 2 (n=1993) treated patients with lower clinical acuity and were less likely to use intracoronary diagnostics, atherectomy, and radial access. Cluster 3 (n=1513) had the lowest case volume, were more likely to work at rural hospitals, and cared for a higher proportion of patients with ST-segment–elevation myocardial infarction and cardiogenic shock. Cluster 4 (n=855) had the highest case volume, were most likely to treat patients with high anatomic complexity and use atherectomy, intracoronary diagnostics, and mechanical support. Compared with cluster 1, adjusted in-hospital mortality was similar for cluster 2 (estimated difference, −0.03 [95% CI, −0.10 to 0.04]), higher for cluster 3 (0.14 [0.07–0.22]), and lower for cluster 4 (−0.15 [−0.24 to −0.06]). Conclusions: Distinct percutaneous coronary intervention operator profiles are differentially associated with patient outcomes. A phenotypic approach to physician assessment may provide actionable feedback for quality improvement.

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

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-009-0956-x ◽

2009 ◽

Vol 13 (9) ◽

pp. 1619-1626 ◽

Cited By ~ 15

Author(s):

Kazuaki Kuwabara ◽

Shinya Matsuda ◽

Kiyohide Fushimi ◽

Koichi B. Ishikawa ◽

Hiromasa Horiguchi ◽

...

Keyword(s):

Laparoscopic Colectomy ◽

Case Volume ◽

Hospital Case

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Revisiting the Relationship Between Hospital Case Volume and Outcomes in Abdominally Based Free Flap Breast Reconstruction

Annals of Plastic Surgery ◽

10.1097/sap.0000000000002308 ◽

2020 ◽

Vol 85 (4) ◽

pp. 397-401

Author(s):

Anmol Chattha ◽

Austin D. Chen ◽

Justin Muste ◽

Justin B. Cohen ◽

Bernard T. Lee ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Case Volume ◽

Hospital Case ◽

The Relationship

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Hospital Case Volume and Clinical Outcomes for Peptic Ulcer Treatment

Journal of General Internal Medicine ◽

10.1007/s11606-008-0721-y ◽

2008 ◽

Vol 23 (10) ◽

pp. 1693-1697 ◽

Cited By ~ 4

Author(s):

Horng-Yuan Lou ◽

Herng-Ching Lin ◽

Kuan-Yang Chen

Keyword(s):

Peptic Ulcer ◽

Clinical Outcomes ◽

Case Volume ◽

Hospital Case ◽

Ulcer Treatment

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Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states

Journal of Neurosurgery ◽

10.3171/jns.2003.99.5.0810 ◽

2003 ◽

Vol 99 (5) ◽

pp. 810-817 ◽

Cited By ~ 162

Author(s):

DeWitte T. Cross ◽

David L. Tirschwell ◽

Mary Ann Clark ◽

Dan Tuden ◽

Colin P. Derdeyn ◽

...

Keyword(s):

Emergency Department ◽

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Hospital Volume ◽

High Volume ◽

Mortality Rates ◽

Case Volume ◽

Content Type ◽

Hospital Case ◽

Fine Print

Object. The goal of this study was to determine whether a hospital's volume of subarachnoid hemorrhage (SAH) cases affects mortality rates in patients with SAH. For certain serious illnesses and surgical procedures, outcome has been associated with hospital case volume. Subarachnoid hemorrhage, usually resulting from a ruptured cerebral aneurysm, yields a high mortality rate. There has been no multistate study of a diverse set of hospitals to determine whether in-hospital mortality rates are influenced by hospital volume of SAH cases. Methods. The authors conducted an analysis of a retrospective, administrative database of 16,399 hospitalizations for SAH (9290 admitted through emergency departments). These hospitalizations were from acute-care hospitals in 18 states representing 58% of the US population. Both univariate and multivariate analyses were used to assess the case volume—mortality rate relationship. The authors used patient age, sex, Medicaid status, hospital region, data source year, hospital case volume quartile, and a comorbidity index in multivariate generalized estimating equations to model the relationship between hospital volume and mortality rates after SAH. Patients with SAH who were treated in hospitals in which low volumes of patients with SAH are admitted through the emergency department had 1.4 times the odds of dying in the hospital (95% confidence interval 1.2–1.6) as patients admitted to high-volume hospitals after controlling for patient age, sex, Medicaid status, hospital region, database year, and comorbid conditions. Conclusions. Patients with a diagnosis of SAH on their discharge records who initially presented through the emergency department of a hospital with a high volume of SAH cases had significantly lower mortality rates. Concentrating care for this disease in high-volume SAH treatment centers may improve overall survival.

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