Associations of Volume and Thyroidectomy Outcomes

2016 ◽  
Vol 155 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Tsung-Jung Liang ◽  
Shiuh-Inn Liu ◽  
King-Tong Mok ◽  
Hon-Yi Shi
Keyword(s):  
Hospital Mortality ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Survival Rates ◽  
High Volume ◽  
Mortality Rates ◽  
Surgeon Volume ◽  
The Mean ◽  
Low Volume ◽  
Mean Cost

Objective This study explored how different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortality. Data Sources MEDLINE and EMBASE databases. Review Methods This study retrospectively analyzed a cohort of 125,037 thyroidectomy patients treated at Taiwan hospitals from 1996 to 2010. Relationships between hospital/surgeon volume and patient outcomes were retrospectively analyzed by propensity score matching. In conjunction with the retrospective study, a systematic review and meta-analysis of the relevant literature also were performed. Results The mean LOS for all thyroidectomies performed during the study period was 3.3 days, and the mean cost was $1193.5. Both high-volume hospitals and high-volume surgeons were associated with significantly shorter LOS and lower costs compared with their low-volume counterparts ( P < .001). Different volume groups had similar in-hospital mortality rates. The meta-analysis results consistently showed that the benefits of high-volume hospitals/surgeons are reduced LOS and costs. However, low in-hospital mortality rates were associated with high-volume surgeons but not with high-volume hospitals. Conclusions This meta-analysis showed that patients who received thyroidectomies performed by high-volume hospitals and surgeons had shorter LOS and lower costs compared with those treated by low-volume hospitals and surgeons. In addition, in-hospital survival rates were better in patients treated by high-volume surgeons. Further research is needed to define the learning curve for thyroidectomy and to clarify how hospital volume and surgeon volume affect its success rate.

High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a “Field Effect” for Pancreaticoduodenectomy?

2016 ◽  
Vol 82 (5) ◽  
pp. 407-411 ◽  
Author(s):  
Thomas W. Wood ◽  
Sharona B. Ross ◽  
Ty A. Bowman ◽  
Amanda Smart ◽  
Carrie E. Ryan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Field Effect ◽  
Hospital Volume ◽  
Patient Discharge ◽  
High Volume ◽  
Surgeon Volume ◽  
Hospital Charges ◽  
Leapfrog Group ◽  
Discharge Status ◽  
Low Volume

Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 “high-volume” surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 “low-volume” surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital “field effect.”

scholarly journals Caseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

2014 ◽  
Vol 120 (3) ◽  
pp. 605-611 ◽  
Author(s):  
Hieronymus D. Boogaarts ◽  
Martinus J. van Amerongen ◽  
Joost de Vries ◽  
Gert P. Westert ◽  
André L. M. Verbeek ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Random Effects ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Relative Weight ◽  
High Volume ◽  
Cochrane Library ◽  
Endovascular Coiling ◽  
Low Volume

Object Increasing evidence exists that treatment of complex medical conditions in high-volume centers is found to improve outcome. Patients with subarachnoid hemorrhage (SAH), a complex disease, probably also benefit from treatment at a high-volume center. The authors aimed to determine, based on published literature, whether a higher hospital caseload is associated with improved outcomes of patients undergoing treatment after aneurysmal subarachnoid hemorrhage. Methods The authors identified studies from MEDLINE, Embase, and the Cochrane Library up to September 28, 2012, that evaluated outcome in high-volume versus low-volume centers in patients with SAH who were treated by either clipping or endovascular coiling. No language restrictions were set. The compared outcome measure was in-hospital mortality. Mortality in studies was pooled in a random effects meta-analysis. Study quality was reported according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Results Four articles were included in this analysis, representing 36,600 patients. The quality of studies was graded low in 3 and very low in 1. Meta-analysis using a random effects model showed a decrease in hospital mortality (OR 0.77 [95% CI 0.60–0.97]; p = 0.00; I2 = 91%) in high-volume hospitals treating SAH patients. Sensitivity analysis revealed the relative weight of the 1 low-quality study. Removal of the study with very low quality increased the effect size of the meta-analysis to an OR of 0.68 (95% CI 0.56–0.84; p = 0.00; I2 = 86%). The definition of hospital volume differed among studies. Cutoffs and dichotomizations were used as well as division in quartiles. In 1 study, low volume was defined as 9 or fewer patients yearly, whereas in another it was defined as fewer than 30 patients yearly. Similarly, 1 study defined high volume as more than 20 patients annually, and another defined it as more than 50 patients a year. For comparability between studies, recalculation was done with dichotomized data if available. Cross et al., 2003 (low volume ≤ 18, high volume ≥ 19) and Johnston, 2000 (low volume ≤ 31, high volume ≥ 32) provided core data for recalculation. The overall results of this analysis revealed an OR of 0.85 (95% CI 0.72–0.99; p = 0.00; I2 = 87%). Conclusions Despite the shortcomings of this study, the mortality rate was lower in hospitals with a larger caseload. Limitations of the meta-analysis are the not uniform cutoff values and uncertainty about case mix.

scholarly journals Outcome of Pancreaticoduodenectomy at Low-Volume Centre (Canakkale State Hospital, Turkey)

2021 ◽  
Vol 10 (26) ◽  
pp. 1926-1930
Author(s):  
Nuri Emrah Goret
Keyword(s):  
Pulmonary Embolism ◽  
State Hospital ◽  
Pancreatic Resection ◽  
High Volume ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Tumor Diameter ◽  
Average Hospital ◽  
The Mean ◽  
Low Volume

BACKGROUND Currently, pancreaticoduodenectomy (PD) is considered a commonly performed surgery for periampullary tumours; but, it is still a high-risk surgical procedure with potential morbidity and mortality rates. Previous studies have identified a significant volume–outcome relationship for hospitals performing pancreaticoduodenectomy (PD). We intended to present the results of patients who underwent pancreatic resection with the diagnosis of malignancy in a low-volume centre. METHODS Patients who underwent pancreatic resection with the diagnosis of malignancy at the 2nd stage state hospital between 2014 and 2018 were included in the study. Patients who underwent pancreatic surgery due to trauma and benign reasons were excluded from the study. Clinical data of the patients have been analysed retrospectively. RESULTS 12 patients participated in our study. 8 patients were male. The average age was 65.75 and the oldest patient was 85 years old. The mean values of preoperative laboratory parameters were HGB gr / dl: 12.3; Albumin gr / dl 3.8 Cea ng / ml 4.08 Ca19.9 U / ml 194 Whipple procedure and the other half was applied distal pancretectomy, the mean tumor diameter was 3.67, the mean number of lymph nodes dissected was 18.1. Postoperative morbidity rate was 33.3. Pancreatic fistula, biliary fistula, wound infection and pulmonary embolism were seen in one patient each. Average hospital stay was 10.66 days. Mortality occurred in patient who had developed pulmonary embolism. CONCLUSIONS Pancreatic resections can be performed safely in low-volume centres, with morbidity and mortality rates comparable to high-volume centers. Patients who have difficulty in accessing high-volume academic centers can be operated in low volume centers. KEY WORDS Pancreatic Cancer, Low Volume Center, Morbidity

scholarly journals Relationship between hospital or surgeon volume and outcomes in joint arthroplasty: protocol for a suite of systematic reviews and dose–response meta-analyses

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022797 ◽  
Author(s):  
Xiang-Dong Wu ◽  
Meng-Meng Liu ◽  
Ya-Ying Sun ◽  
Zhi-Hu Zhao ◽  
Quan Zhou ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Dose Response ◽  
Data Extraction ◽  
Meta Analysis ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Surgeon Volume ◽  
Published Data ◽  
Records Management ◽  
Meta Analyses

IntroductionJoint arthroplasty is a particularly complex orthopaedic surgical procedure performed on joints, including the hip, knee, shoulder, ankle, elbow, wrist and even digit joints. Increasing evidence from volume–outcomes research supports the finding that patients undergoing joint arthroplasty in high-volume hospitals or by high-volume surgeons achieve better outcomes, and minimum case load requirements have been established in some areas. However, the relationships between hospital/surgeon volume and outcomes in patients undergoing arthroplasty are not fully understood. Furthermore, whether elective arthroplasty should be restricted to high-volume hospitals or surgeons remains in dispute, and little is known regarding where the thresholds should be set for different types of joint arthroplasties.Methods and analysesThis is a protocol for a suite of systematic reviews and dose–response meta-analyses, which will be amended and updated in conjunction with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Electronic databases, including PubMed and Embase, will be searched for observational studies examining the relationship between the hospital or surgeon volume and clinical outcomes in adult patients undergoing primary or revision of joint arthroplasty. We will use records management software for study selection and a predefined standardised file for data extraction and management. Quality will be assessed using the Newcastle-Ottawa Scale, and the meta-analysis, subgroup analysis and sensitivity analysis will be performed using Stata statistical software. Once the volume–outcome relationships are established, we will examine the potential non-linear relationships between hospital/surgeon volume and outcomes and detect whether thresholds or turning points exist.Ethics and disseminationEthical approval is not required, because these studies are based on aggregated published data. The results of this suite of systematic reviews and meta-analyses will be submitted to peer-reviewed journals for publication.PROSPERO registration numberCRD42017056639.

Outcomes of total hip arthroplasty using dualmobility cups for femoral neck fractures: a systematic review and meta-analysis

2020 ◽  
pp. 112070002092665
Author(s):  
Syed H Mufarrih ◽  
Nada Q Qureshi ◽  
Bassam Masri ◽  
Shahryar Noordin
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Femoral Neck Fractures ◽  
Cochrane Library ◽  
Total Hip ◽  
The Mean

Objectives: Femoral neck fractures (FNFs), with up to 15% mortality, are prominent orthopaedic emergencies. After treating FNFs, dislocation is another challenge increasing morbidity, mortality and treatment costs substantially. The emerging dual-mobility cup (DMC) may decrease dislocation rates following total hip arthroplasty (THA) for FNFs. We performed a systematic review of literature reporting dislocation and mortality rates with DMC-THA for the treatment of FNFs. Methods: 2 authors independently searched PubMed (MEDLINE), Google Scholar and Cochrane library for studies reporting dislocation and mortality rates for FNFs treated with DMC-THA since inception up to January 2019. Data on outcomes of interest was extracted from all studies and assessed for eligibility for a meta-analysis. Results: Out of 522 search results, 18 studies were included in the systematic review and 4 in the meta-analysis. The mean rate of dislocation following DMC-THA for FNFs was found to be 1.87% ± 2.11, with a 1-year mortality rate of 14.0% ± 10.55. Results of meta-analysis showed that dislocation and 1-year postoperative mortality rates were significantly lower for DMC-THA with a risk ratio 0.31 (95% CI, 0.16–0.59; I2 = 0%, p  = 0.0003) and 0.55 (0.40, 0.77; I2 = 0%, p = 0.003) respectively when compared to biploar hemiathroplasty (BHA). Conclusions: The mean dislocation and mortality rates in DMC-THA are lower than previously reported rates for THA with single cup and comparable to unipolar and bipolar hemiarthroplasty. Further research involving randomised control trials to assess differences in outcomes, longevity and cost-effectiveness needs to be conducted to make recommendations for the use of DMC in treating FNFs.

scholarly journals Mortality and Survival Rates after Elective Hepatic Surgery in a Low-Volume Centre Are Comparable to Those of High-Volume Centres

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
I. E. Nygård ◽  
K. Lassen ◽  
J. Kjæve ◽  
A. Revhaug
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Survival Rates ◽  
Disease Free Survival ◽  
High Volume ◽  
Colorectal Metastases ◽  
Rank Test ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Low Volume

Background. Over the last decades, liver resection has become a frequently performed procedure in western countries because of its acceptance as the most effective treatment for patients with selected cases of metastatic tumours. The purpose of this study was to evaluate the results after hepatic resections performed electively in our centre since 1979 and compare the results to those of larger high-volume centres. Methods. Medical records of all patients who underwent liver resection from January 1979 to December 2011 were reviewed. Disease-free survival and overall survival were determined by Kaplan-Meier analysis. Risk factors for complications were tested with the log-rank test and the Cox proportional hazard model. Complications were classified according to the modified Clavien classification system. Results. 290 elective liver resections were performed between January 1979 and December 2011. There were 171 males (59.0%) and 119 females (41.0%). Median age was 63 years, range 1–87. Overall survival ranged from 0 to 383 months, with a median of 31 months. Five-year survival rate for patients who underwent liver resection for colorectal metastases was 35.8% (34/95). Discussion. Hepatic resections are safely performed at a low-volume centre, with regard to perioperative- and in-house mortality and 5-year survival rates.

scholarly journals SIMULTANEOUS AND STAGED RESECTIONS FOR SYNCHRONOUS COLORECTAL LIVER METASTASES: META-ANALYSIS

2017 ◽  
pp. 6-21 ◽  
Author(s):  
A. A. Ponomarenko ◽  
Yu. A. Shelygin ◽  
E. G. Rybakov ◽  
S. I. Achkasov
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Mortality Rates ◽  
Synchronous Colorectal Liver Metastases ◽  
Overall Survival Rates

AIM. To analyze the short-term and long-term outcomes two alternative surgical strategies: 1) simultaneous resections for colorectal cancer and synchronous colorectal liver metastases;2) conventional surgery for the primary tumor during the initial operation. After time, the liver resection is performed at a second operation METHODS. Meta-analysis was performed to compare outcomes simultaneous resections for colorectal cancer and synchronous colorectal liver metastases and staged surgery. Tumor localization, spread and number of metastasis, extent of operation, blood loss, length of hospital stay, postop mortality, complication rates, overall survival rates were analyzed. RESULTS. Twenty-nine studies with 5518 patients were included in meta-analysis. Multiple (р=0,007) and bilobed (р=0,0004) metastasis were more often in patients in group ofstaged resections. Major hepatectomy was also performed more often in group of staged resections. There were no significant differences in blood loss and postopirative mortality rates (p>0,05). Complication rate in group of simultaneous resections was lower than in group of staged resections (0R=0,8, 95 %CI: 0,7-1.0, p=0,048). 3- and 5-year overall survival rates were similar in both groups: 54% vs 55 %, and 37% vs 38%, respectively (р=0,007). CONCLUSION. Simultaneous resection of the primary tumor and the minor liver resection or extended hepatectomy in selected patients didn’t adversely affect on complications and mortality rates in equivalent long-term survival compared to staged liver resection. An important limitation of the present study is the bias and heterogeneity in compared groups due to retrospective data over the 20-year period.

scholarly journals Anticoagulation Practices and Mortality in Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lei zhang ◽  
Miao Liu ◽  
Meng Wang ◽  
Lina Liu ◽  
Caiwei Lin ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Hospital Mortality ◽  
Major Bleeding ◽  
Data Extraction ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Cochrane Central Register ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Extracorporeal Cardiopulmonary Resuscitation

Abstract Objective: This study sought to evaluate the effect of different anticoagulant methods on in-hospital mortality, bleeding, and thromboembolic complications of patients receiving extracorporeal cardiopulmonary resuscitation (ECPR).Data Sources: We searched the relevant literature concerning ECPR and anticoagulation indexed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from 1995 until May 2020. Study Selection: The anticoagulation information and outcomes data (i.e., anticoagulation targets and strategy, major bleeding and thromboembolic events, and in-hospital mortality rate) were extracted. A random-effects meta-analysis was performed to analyze these data.Data Extraction: Twenty-seven studies (N = 1,302 patients) were included; of these, 16 studies (n = 672 patients) included data regarding bleeding and thromboembolic complications. Data Synthesis:The summary prevalence for in-hospital mortality was 70% [95% confidence interval (CI): 65%–74%, I2 = 68.3%], the summary prevalence for major bleeding was 27% (95% CI: 19%–35%, I2 = 84.1%), and the summary prevalence for thromboembolic events was 8.7% (95% CI: 5.2%–13.4%, I2 = 71.4%).Conclusions: Controversy persists regarding whether to administer loading heparin and in making the choice of target anticoagulant dose. Currently, limited evidence suggests that low target anticoagulant doses may benefit patients. There is a need for further investigation of optimal anticoagulation strategies in patients receiving ECPR, preferably in randomized trials or well-designed observational studies and with clearly defined outcomes.

scholarly journals Short Term Outcomes of Gastric Cancer at University Teaching Hospital of Kigali (CHUK), Rwanda.

2020 ◽  
Author(s):  
Irénée Niyongombwa ◽  
Irénée David Karenzi ◽  
Isaie Sibomana ◽  
Vital Muvunyi ◽  
Jean Marie Vianney Kagimbangabo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Advanced Disease ◽  
Survival Rates ◽  
University Teaching ◽  
Short Term ◽  
The Mean

Abstract Background: Gastric cancer is the 4th most common cause of cancer death worldwide with an annual global incidence of 985,600; two thirds of them being in the developing countries. Gastric cancer is endemic in the so called stomach cancer region comprising Rwanda, Burundi, South Western Uganda and eastern Kivu province of Democratic Republic of Congo and its incidence in Rwanda is estimated around 13 to 15 per 100,000 population. To date, the outcomes of gastric cancer in the East African region are under investigated, and the survival rate in Rwanda is not known. The aim of this study was to describe the short term outcomes (in-hospital mortality rate, length of hospital stay, 3, 6, 12 and 24 months survival rates) in patients treated for gastric cancer at CHUK.Methods: We retrospectively reviewed the data collected from records of patients who consulted CHUK over a period of 10 years from September 2007 to August 2016. Patients were followed in hospital and after discharge for survival length. Descriptive statistics were used for baseline demographic data, Kaplan-Meier model and univariate cox regression were used for survival analysis.Results: Of the 199 patients enrolled in the study, 92 (46%) were males and 107 (54%) females. The mean age was 55.4 ranging between 24 and 93. The mean symptoms duration was 15 months. Most patients consulted with advanced disease, 62.3% with distant metastases. Treatment with curative intent was offered for only 19.9% of patients. The in-hospital mortality rate was 13.3%. The 3, 6, 12 and 24 months survival rate was 52%, 40.5%, 28% and 23.4% respectively. The Overall survival rate was 7 months.Conclusion: Patients with gastric cancer have delayed consultations and advanced disease at the time of presentation. This cancer is associated with poor outcomes in terms of hospital mortality and post discharge survival rates.

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