Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm

2009 ◽  
Vol 75 (10) ◽  
pp. 932-936 ◽  
Author(s):  
Kevin M. Reavis ◽  
Marcelo W. Hinojosa ◽  
Brian R. Smith ◽  
James B. Wooldridge ◽  
Sindhu Krishnan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Gastric Surgery ◽  
National Database ◽  
Medical Centers ◽  
Outcome Relationship ◽  
Academic Medical ◽  
Low Volume ◽  
Poor Outcomes ◽  
The University

Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.

scholarly journals Impact of state medicaid expansion status on length of stay and in-hospital mortality for general medicine patients at US academic medical centers

2016 ◽  
Vol 11 (12) ◽  
pp. 847-852 ◽  
Author(s):  
Mary E. Anderson ◽  
Jeffrey J. Glasheen ◽  
Debra Anoff ◽  
Read Pierce ◽  
Molly Lane ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
General Medicine ◽  
Academic Medical Centers ◽  
Medicaid Expansion ◽  
Medical Centers ◽  
Academic Medical

Utilization of Laparoscopy in Colorectal Surgery for Cancer at Academic Medical Centers: Does Site of Surgery Affect Rate of Laparoscopy?

2011 ◽  
Vol 77 (10) ◽  
pp. 1300-1304 ◽  
Author(s):  
Joseph C. Carmichael ◽  
Hossein Masoomi ◽  
Steven Mills ◽  
Michael J. Stamos ◽  
Ninh T. Nguyen
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Laparoscopic Colorectal Surgery ◽  
Right Hemicolectomy ◽  
Academic Medical Centers ◽  
Sigmoid Colectomy ◽  
Colorectal Cancer Surgery ◽  
Medical Centers ◽  
Academic Medical ◽  
The University

Use of laparoscopy in colorectal cancer surgery is still limited. The aim of this study was to determine the rate of use of laparoscopic colorectal surgery for cancer at academic medical centers and to evaluate if the site of surgery influences the rate of use. Clinical data of patients who underwent laparoscopic or open colon and rectal resections for cancer from 2007 to 2009 were obtained from the University HealthSystem Consortium database. Data concerning rate of laparoscopy, length of stay, morbidity, and risk-adjusted mortality were obtained. During the 36-month study period, 22,780 operations were performed. The overall rate for use of laparoscopy was 14.8 per cent. Laparoscopy was most often used for total colectomy (22.6%), sigmoid colectomy (17.3%), cecectomy (17.1%), and right hemicolectomy (17.0%). Laparoscopy was most infrequently used for abdominoperineal resection (8.0%), transverse colectomy (10.0%), and left hemicolectomy (13.1%). Length of stay for laparoscopic colon and rectal procedures was 3.2 days shorter than for open surgery. Although the benefits of laparoscopic colorectal surgery for cancer have been demonstrated, the use of laparoscopy for colorectal resection remains under 20 per cent for colon cancer and under 10 per cent for rectal cancer. Further studies are needed to determine the factors limiting the use of laparoscopy in colorectal surgery.

scholarly journals Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre

2019 ◽  
Vol 28 (6) ◽  
pp. 449-458 ◽  
Author(s):  
Steven C Chatfield ◽  
Frank M Volpicelli ◽  
Nicole M Adler ◽  
Kunhee Lucy Kim ◽  
Simon A Jones ◽  
...  
Keyword(s):  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Hospital Mortality ◽  
Cost Of Care ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Series Analysis ◽  
Academic Medical ◽  
The Cost

BackgroundReducing costs while increasing or maintaining quality is crucial to delivering high value care.ObjectiveTo assess the impact of a hospital value-based management programme on cost and quality.DesignTime series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.InterventionNYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme.MeasurementsChange in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.ResultsThe programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI −0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million.LimitationsObservational analysis.ConclusionA systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.

Issues in Developing the Medical Scientist, Part 1: Interview with Dr. Robert W. Schrier, MD

2004 ◽  
Vol 52 (4) ◽  
pp. 242-245
Keyword(s):  
Department Chair ◽  
Academic Medical Centers ◽  
Renal Diseases ◽  
Full Time ◽  
Institute Of Medicine ◽  
University Of Colorado ◽  
Medical Centers ◽  
Academic Medical ◽  
The University ◽  
Time Faculty

The American Federation for Medical Research (AFMR) will present a series of articles that address the challenges faced by academic medical centers and other institutions in developing medical scientists (see the accompanying introduction to the series on page 241). The goal of this series is to assist leaders at academic medical centers in addressing the challenges for training the next generation of health care investigators. In addition, we hope to educate junior investigators and trainees on the many issues that their facilitators and mentors face in developing adequate programs for training and career development.Our first part of this series is an interview with Robert W. Schrier, MD. Dr. Schrier is a professor of medicine and was chairman of the Department of Medicine at the University of Colorado School of Medicine for 26 years and head of the Division of Renal Diseases and Hypertension for 20 years. Dr. Schrier's research accomplishments are enormous. He has had continuous funding for 35 years and has authored over 800 scientific papers and edited 45 books in renal medicine, geriatrics, drug use, and kidney disease. He is an acknowledged leader in academic medicine, as evidenced by his election to the Institute of Medicine of the National Academy of Sciences and presidencies of the Association of American Physicians, the American Society of Nephrology, the National Kidney Foundation, and the International Society of Nephrology. Dr. Schrier is a master of the American College of Physicians and an honorary fellow of the Royal College of Physicians. In addition, he has received the highest awards of several national and international organizations.However, it is not only the personal accomplishments of Dr. Schrier that led to his selection to take part in this series. Although those personal accomplishments are incredible, his work as a department chair, division chief, and research mentor may be greater. During Dr. Schrier's 26 years as chair of the Department of Medicine at the University of Colorado, the full-time faculty increased from approximately 75 to 500. The annual research grants by the department's full-time faculty rose from approximately $3 to $100 million, including the faculties' contributions to the General Clinical Research and Cancer Centers. The housestaff and fellow training programs also became nationally prominent. Thirty endowed research chairs between $1.5 and $2.0 million each were established. Clearly, he is a visionary who can speak to the challenges facing the young medical scientists and their mentors today.Dr. Schrier's responses to a series of questions follow.

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

2020 ◽  
Vol 38 (1) ◽  
pp. 47-53
Author(s):  
Venkataraghavan Ramamoorthy ◽  
Muni Rubens ◽  
Anshul Saxena ◽  
Chintan Bhatt ◽  
Sankalp Das ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
National Database ◽  
Hospital Outcomes ◽  
Inpatient Hospital ◽  
Male Sex

Objective: Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. Methods: The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. Results: There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Conclusions: Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.

Increasing Utilization of Laparoscopic Gastric Banding in the Adolescent: Data from Academic Medical Centers, 2002-2009

2011 ◽  
Vol 77 (11) ◽  
pp. 1510-1514 ◽  
Author(s):  
Ninh T. Nguyen ◽  
Farah Karipineni ◽  
Hossein Masoomi ◽  
Kelly Laugenour ◽  
Kevin Reavis ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Hospital Mortality ◽  
Gastric Banding ◽  
Laparoscopic Gastric Banding ◽  
Academic Medical Centers ◽  
Perioperative Outcomes ◽  
Patients Âgés ◽  
Medical Centers ◽  
Academic Medical ◽  
Adolescent Bariatric Surgery

Bariatric surgery in the adolescent continues to be a controversial topic. This study compared the utilization and perioperative outcomes of adolescent bariatric surgery performed at academic centers from 2002 to 2006 versus 2007 to 2009. We obtained data from the University HealthSystem Consortium for all adolescent patients (ages 12-18 years) who underwent bariatric surgery for the treatment of morbid obesity between 2002 and 2009. Outcomes including type of procedure, characteristics, length of stay, 30-day readmission, morbidity, and in-hospital mortality were compared between the two time periods. From 2007 to 2009, 340 adolescents underwent bariatric surgery at 63 academic hospitals. The mean number of adolescent bariatric procedures performed/year increased from 61.8 in 2002 to 2006 to 113.3 procedures/year in 2007 to 2009. There was an increase in utilization of laparoscopic gastric banding from 29 per cent to 50 per cent with a decrease in utilization of gastric bypass from 62 per cent to 48 per cent, respectively. For 2007 to 2009, the overall morbidity was 2.9 per cent with a 30-day readmission of 1.5 per cent and an in-hospital mortality of 0 per cent. Within the context of academic medical centers, adolescent bariatric surgery is associated with low morbidity and no mortality. Compared with 2002 to 2006, there has been an increase in the number of adolescent bariatric operations with increase in utilization of the laparoscopic gastric banding.

scholarly journals Higher CICU mechanical ventilation volumes are associated with lower in-hospital mortality

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
S Nandiwada ◽  
S Islam ◽  
J Jentzer ◽  
PE Miller ◽  
CB Fordyce ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Invasive Mechanical Ventilation ◽  
High Volume ◽  
Coronary Intervention ◽  
Annual Volume ◽  
Low Volume

Abstract Funding Acknowledgements Type of funding sources: None. Background  The incidence of respiratory failure and the provision of invasive and non-invasive mechanical ventilation (MV) in patients admitted to cardiac intensive care units (CICU) are increasing. While institutional MV volumes are associated with reduced mortality in medical and surgical ICUs, this relationship has not been characterized in the CICU population. Purpose  By describing the relationship between institutional MV volume and outcomes in the CICUs, we hope to shed light on minimum volume benchmarks for providing MV. Methods  National Canadian population-based data from 2005 to 2015 was used to identify patients admitted to CICUs requiring MV. CICUs were categorized into low (≤100), intermediate (101-300), and high (>300) volume centers based on spline knots identified in the association between annual MV volume and mortality (Figure). Outcomes of interests included all-cause in-hospital mortality, the proportion of patients requiring prolonged MV (>96 hours) and CICU length of stay (LOS). Results  Among the 47,173 CICU admissions that required MV, 89.5% (42,200) required invasive mechanical ventilation. The median annual CICU MV volume was 127 (range 1-490). In-hospital mortality was lower in intermediate (29.2%, adjusted odds ratio [aOR] 0.84, 95% CI 0.72-0.97, p = 0.019) and high-volume (18.2%; aOR 0.82, 95% CI 0.66-1.02, p = 0.076) centers, compared to low volume centers (35.9%). The proportion of patients requiring prolonged MV was higher in low-volume (29.2%) compared to high-volume (14.8%, OR 0.70, 95% 0.55-0.89, p = 0.003) centers. Point estimates for mortality and prolonged MV were lower in PCI-capable and academic centers (Table). Significantly (p <0.01) lower CICU LOS was observed only in the subgroup of PCI-capable intermediate- and high-volume hospitals. Conclusions  In a national dataset, we observed that higher CICU MV hospital volumes were associated with lower in-hospital mortality, CICU LOS, and fewer episodes of prolonged MV. Pending further validation, these data suggest minimum MV volume benchmarks for CICUs caring for patients with respiratory failure. Further research is warranted to explore these associations in more detail. Unadjusted volume-outcome relationshipsOutcomesGroup 1 Annual Volume ≤100Group 2 Annual Volume 101-300Group 3 Annual Volume >300Totalp-valueTotal N1770224351512047173In-hospital mortality6357 (35.0%)7122 (29.2%)933 (18.2%)14412 (30.6%)p < 0.0001Median CICU LOS(hours)85796679p < 0.0001Episodes of prolonged MV5161 (29.2%)5608 (23.0%)758 (14.8%)11527 (24.4%)p < 0.0001Abbreviations OR (odds ratio), RD (risk difference), CI (confidence interval), PCI (percutaneous coronary intervention), LOS (length of stay)Abstract Figure. Annual CICU MV volume and mortality

scholarly journals Bed-to-Bed Transfer Program Among Patients Who Need Hospitalization in a Crowded Emergency Department in Taiwan

2021 ◽  
Author(s):  
Nai-Wen Ku ◽  
Chu-Lin Tsai ◽  
Shyr-Chyr Chen ◽  
Chien-Hua Huang ◽  
Cheng-Chung Fang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Medical Records ◽  
Medical Center ◽  
Transfer Program ◽  
Medical Centers ◽  
Regional Hospitals

Background: Emergency department (ED) crowding is a universal issue. In Taiwan, patients with common medical problems prefer to visit ED of medical centers, resulting in overcrowding. Thus, a bed-to-bed transfer program has been implemented since 2014. However, there was few studies that compared clinical outcomes among patients who choose to stay in medical centers to those being transferred to regional hospitals. The aim of this study was to explore the transfer rate, delineate the factors related to patient transfer, and clarify the influence upon the program outcomes. Methods: A retrospective cohort study was conducted using demographic and clinical disease factors from the patient electronic referral system, electronic medical records (EMRs) of a medical center in Taipei, and response to referrals from regional hospitals. The study included adult patients who were assessed as appropriate for transfer in 2016. We analyzed the outcomes (length of stay and mortality rate) between the referrals were accepted and refused using propensity score matching. Results: Of the 1759 patients eligible for transfer to regional hospitals, 420 patients (24%) accepted the referral. Medical records were obtained from the regional hospitals for 283 patients (67%). After propensity score matching, the results showed that interhospital transfer resulted in similar median total length of stay (8.7 days in the medical center vs 7.9 days in regional hospitals; P=.245). In-hospital mortality was low for both groups (3.1% in the medical center vs 1.3% in regional hospitals; P=.344). Conclusion: Transfer from an overcrowded ED in a medical center to regional hospitals in eligible patients results in non-significant outcome of total length of stay. With the caveat of an underpowered sample, we did not find statistically significant differences in in-hospital mortality. This healthcare delivery model may be used in other cities facing similar problems of ED overcrowding.

scholarly journals 907. The HCV Care Continuum Among Hospitalized Persons Who Inject Opiates: Missed Opportunities for Screening and Referral to Treatment

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S545-S545
Author(s):  
Irene Kuo ◽  
Jillian S Catalanotti ◽  
Hana Akselrod ◽  
Keanan McGonigle ◽  
William Mai ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Medical System ◽  
Hcv Infection ◽  
Academic Medical Centers ◽  
Hcv Treatment ◽  
Research Support ◽  
Medical Centers ◽  
Academic Medical ◽  
Research Grant

Abstract Background Despite an effective cure, hepatitis C virus (HCV) remains a major public health problem for persons who inject opiates. Hospitalization provides an opportunity to identify chronic HCV infection and provide referral and linkage to outpatient care upon discharge. We examined the HCV care continuum among hospitalized persons who inject drugs and have opiate use disorder (OUD). Methods The CHOICE Study is a retrospective chart review of adults hospitalized with infectious complications of OUD and injection drug use at four academic medical centers (University of Maryland, George Washington University, University of Alabama, and Emory University). The sample included patients hospitalized between 1/1/2018-12/31/2018, had ICD9/10 diagnosis codes consistent with OUD and acute bacterial/fungal infection, and chart review verification of active infection associated with OUD. Data on HCV antibody (Ab) and RNA testing and referral to HCV treatment within the medical system were abstracted from medical records. Results Of 287 patients, median age was 40 (IQR: 32-52), 59% were male, and 63% were white and 34% black. Overall, 38% (n=108) had known HCV infection at hospitalization; of those with unknown status, only 41% (n=73) were screened for HCV. Among those, 67% were HCV Ab+. Of patients who were HCV Ab+ or had known HCV infection (n=157), only 52% were tested for HCV RNA, of whom 61% had detectable RNA. Only 40% of those with detectable RNA received a treatment referral prior to discharge (Fig. 1). The length of stay of the admission was not associated with treatment referral, but a shorter length of stay was significantly associated with not being screened for HCV Ab or RNA tested (p< 0.05). Of five patients who were referred to care within the medical system, four initiated HCV treatment, and two achieved known sustained viral response. Figure 1. HCV Continuum of care for hospitalized patients who inject drugs with opioid use disorder (OUD) at four academic medical centers in the United States, January 2018-December 2018 Conclusion Hospitalization is a missed opportunity for HCV screening and linkage. Despite opportunities to address HCV infection among this highly impacted population, there were sizeable gaps in the HCV continuum of care among hospitalized persons who inject opiates. Structural reasons such as length of stay may be a factor in implementing HCV testing. Disclosures Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Ellen Eaton, MD , Gilead (Grant/Research Support) Ellen Eaton, MD , Gilead (Individual(s) Involved: Self): Research Grant or Support Greer A. Burkholder, MD, MSPH, Eli Lilly (Grant/Research Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)

Sign in / Sign up

Export Citation Format

Share Document