Impact of hospital type and surgical volume on outcomes of biliary cancer resection.

e16168 Background: The mainstay of treatment for patients with early-stage biliary cancer (gallbladder or cholangiocarcinoma) is surgical resection. Herein, we evaluated the predictors for biliary cancer resection outcome and association with hospital volume and teaching status. Methods: A national representative cohort of 18485 biliary cancer patients was included for the years 2016 – 2018 from the national inpatient sample database. The study population included patients ≥ 18 years diagnosed with biliary cancer who underwent elective surgical resection (ICD 10). Hospitals were categorized based on teaching status (yes, if ACGME approved residency program, member of the council of teaching hospitals, or with residents to beds ratio of .25 or higher, versus non-teaching); and hospital volume (high if ≥ 20 biliary cancer surgeries performed per year, otherwise low). The primary outcome was biliary resection and the secondary outcomes included post-operative complications, in-hospital mortality, length of stay (< or ≥ 7 days), and health care cost (< or ≥ median) based on hospital teaching status and biliary cancer surgical volume. Association with outcomes was assessed using multivariable logistic regression models adjusted for age, sex, race, household income, service payer, Elixhauser co-morbidity score, hospital volume, teaching status, bed size, location, and region. Results: Out of 18,485 patients hospitalized with biliary cancer, 7,030 patients underwent elective biliary cancer resection during the study period. Patients undergoing resection were likely to have higher than national household median income with Medicare as primary insurance payor. In multivariate adjusted logistic regression models, high volume centers showed significantly lower length of stay (adjusted odds ratio (aOR) 0.73; 95% CI 0.54 - 0.97; p=0.03), and lower in-hospital mortality (aOR 0.28; 95% CI 0.15 - 0.80; p=0.01), but no significant difference in post-operative complications or healthcare cost compared to low volume centers. Surgeries performed in a teaching hospital were associated with decreased risk of post-operative complications (aOR 0.74; 95% CI 0.55 - 1.0; p=0.05), significant decrease in in-hospital mortality (aOR 0.44; 95% CI 0.27 - 0.69; p=0.001), but higher inflation-adjusted healthcare cost (aOR 1.77; 95% CI 1.37-2.26; p<0.001) with no difference in length of stay. Conclusions: Patients who underwent elective biliary cancer surgery at a teaching or high-volume hospital had a significant decrease in their risk of in-hospital mortality. Additionally, surgeries at teaching hospitals were associated with a significantly lower post-operative complication rate compared to similar procedures at a non-teaching hospital, although teaching hospitals did have a significantly higher healthcare cost when adjusted for length of stay.

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Abstract 14634: Hospital Teaching Status and Variation in Outcomes: Evidence From Patients Undergoing Multi-vessel Percutaneous Coronary Interventions

Circulation ◽

10.1161/circ.142.suppl_3.14634 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Temitope Ajibawo ◽

◽

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Coronary Intervention ◽

Hospital Charges ◽

Teaching Hospitals ◽

Chi Square ◽

Hospital Outcomes ◽

Nationwide Inpatient Sample Database ◽

Percutaneous Coronary ◽

Teaching Status

Background and Objectives: Evidence suggests variations in medical services provided by hospital teaching status. However, there is limited data on how it affects hospital outcomes. The aim of this study is to examine differences in outcomes among patients who underwent multi-vessel percutaneous coronary intervention (MVPCI) stratified by hospital teaching status. Methods: We queried the 2016 Nationwide Inpatient Sample database and identified patients who underwent MVPCI using ICD-10 procedure codes. Hospital teaching status was classified as urban teaching vs. non- teaching. Chi-square and Wilcoxon rank-sum tests were used to compare the following outcomes between hospitals: patient demographics, clinical outcomes, in-hospital mortality, length of stay (LOS), and total charges. Results: Among the 15,611 MVPCI procedures performed, 73.5% were done in teaching hospitals. 68.4% of the MVPCI in teaching hospitals were in males and 54.1% in patients aged ≥65 years. Teaching hospitals had a lower proportion of whites (74.1% vs 79.5%, p<0.001). Teaching and non-teaching hospitals did not differ significantly in impella use (1.7% vs 1.7%, p=0.9928), IABP use (2.2% vs. 2.3%, p=0.7156) and in-hospital mortality (2.0% vs 2.2% p=0.3399). The incidence of acute renal failure (14.0% vs 13.5%, p=0.3858), cardiogenic shock (4.5% vs 4.7%, p=0.5969), cardiac tamponade (0.2% vs 0.2% p=0.5769), and ventricular fibrillation (2.6% vs 2.9%, p=0.2570) did not differ significantly. However, the median length of stay (LOS) (3 vs 2 days, p=0.0075) and hemorrhage requiring transfusion (HRT) (5.6% vs 4.7%, p=0.0414) were significantly greater in teaching centers. In contrast, total hospital charges ($96,465 vs. $106,711, p<0.0001) was lower in teaching centers. Conclusion: Our analysis did not show any differences with regards to in-hospital deaths, IABP use, impella use and many of the hospital outcomes in MVPCI. In teaching centers, the occurrence of HRT and the mean LOS was increased, but there was no increased financial costs.

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MP69-05 EVALUATION OF POST-OPERATIVE COMPLICATIONS AND PROLONGED LENGTH OF STAY FOLLOWING CYTOREDUCTIVE NEPHRECTOMY

The Journal of Urology ◽

10.1016/j.juro.2015.02.2509 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Boris Gershman ◽

Daniel Moreira ◽

Stephen Boorjian ◽

Christine Lohse ◽

John Cheville ◽

...

Keyword(s):

Length Of Stay ◽

Cytoreductive Nephrectomy ◽

Prolonged Length ◽

Operative Complications ◽

Post Operative Complications

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Nationwide in‐hospital mortality following colonic cancer resection according to hospital volume in Germany

BJS Open ◽

10.1002/bjs5.50173 ◽

2019 ◽

Vol 3 (5) ◽

pp. 672-677 ◽

Cited By ~ 6

Author(s):

J. Diers ◽

J. Wagner ◽

P. Baum ◽

S. Lichthardt ◽

C. Kastner ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Volume ◽

Colonic Cancer ◽

Cancer Resection

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Cranioplasty length of stay: Relationship with indication, surgical decision-making factors, and sex

Trauma ◽

10.1177/1460408619892141 ◽

2019 ◽

Vol 22 (4) ◽

pp. 256-264

Author(s):

Weston Northam ◽

Avinash Chandran ◽

Crystal Adams ◽

Nikki E. Barczak-Scarboro ◽

Carolyn Quinsey

Keyword(s):

Decision Making ◽

Length Of Stay ◽

Average Length ◽

Surgical Decision ◽

Average Length Of Stay ◽

Covariate Effects ◽

Operative Complications ◽

Decision Making Factors ◽

Surgical Decision Making ◽

Post Operative Complications

Objectives Cranioplasty is being performed more often due to rising rates of decompressive craniectomy. Hospital length of stay is a quality metric which has not been directly studied after cranioplasty. This study aims to identify factors associated with length of stay after cranioplasty to better understand their outcomes. Patients and methods A retrospective review was conducted at a single academic center from 2007 to 2015 for all patients >18 years of age who received cranioplasty. Baseline data from 148 patients were recorded including demographics, clinical characteristics, and surgeon decision-making factors for cranioplasty. Post-operative complications within 30 days after cranioplasty were recorded in addition to disposition and discharge data. Weibull accelerated failure time models were used to identify significant associations with length of stay after cranioplasty. Results The overall post-operative complication rate was 27.0%, and the most frequent indication for craniectomy was traumatic brain injury. The majority (72.3%) of patients returned home, compared to other disposition, and median length of stay was 2.0 days (interquartile range = 2.0). Average length of stay was 7.7 days in men, as compared with 2.4 days in women, and even upon adjusting for covariate effects, length of stay was longer in men than in women irrespective of post-operative complications. When time-to-cranioplasty fell between 0 and 30 days, average length of stay was 19.2 days, as compared with 10.3 days when time-to-cranioplasty fell between 30 and 90 days, and 2.5 days when time-to-cranioplasty was >90 days. After adjustment for covariate effects, the association between time-to-cranioplasty and length of stay was maintained only in patients without post-operative complications. Conclusions Length of stay can inform our understanding of outcomes after cranioplasty. In our study, length of stay was associated with sex, indication for craniectomy, and surgical decision-making (time-to-cranioplasty and implant material), but time-to-cranioplasty was only associated in patients without post-operative complications. These relationships should be seen not as direct causation, but rather as tools to add to our understanding of this relatively complicated procedure.

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Association of Resident Duty Hour Restrictions on Mortality of Nervous System Disease and Disorder

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00306.1 ◽

2016 ◽

Vol 8 (4) ◽

pp. 576-580 ◽

Cited By ~ 1

Author(s):

Ian Churnin ◽

Joel Michalek ◽

Ali Seifi

Keyword(s):

Nervous System ◽

Hospital Mortality ◽

Nationwide Inpatient Sample ◽

Teaching Hospitals ◽

Nonteaching Hospital ◽

System Disease ◽

Significant Difference ◽

Reform Period ◽

Teaching Status ◽

The Impact

ABSTRACT Background The impact of the 2003 residency duty hour reform on patient care remains a debated issue. Objective Determine the association between duty hour limits and mortality in patients with nervous system pathology. Methods Via a retrospective cohort study using the Nationwide Inpatient Sample from 2000–2010, the authors evaluated in-hospital mortality status in those with a primary discharge level diagnosis of disease or disorder of the nervous system. Odds ratios were calculated, and Bonferroni corrected P values and confidence intervals were determined to account for multiple comparisons relating in-hospital mortality with teaching status of the hospital by year. Results The pre-reform (2000–2002) and peri-reform (2003) periods revealed no significant difference between teaching and nonteaching hospital mortality (P > .99). The post-reform period (2004–2010) was dominated by years of significantly higher mortality rates in teaching hospitals compared to nonteaching hospitals: 2004 (P < .001); 2006 (P = .043); 2007 (P = .042); and 2010 (P = .003). However, data for 2005 (P ≥ .99), 2008 (P = .80), and 2009 (P = .09) did not show a significant difference in mortality. Conclusions Teaching and nonteaching hospital mortality was similar in patients with nervous system pathology prior to the duty hour reform. While nonteaching institutions demonstrated steadily declining mortality over the decade, teaching hospital mortality spiked in 2004 and declined at a more restricted rate. The timing of these changes could suggest a negative correlation of duty hour restrictions on outcomes of patients with nervous system pathology.

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541 IS HOSPITAL VOLUME A DETERMINANT OF TYPE OF SURGERY, COMPLICATIONS, LENGTH OF STAY, AND IN-HOSPITAL MORTALITY IN NON-METASTATIC RENAL CELL CARCINOMA?

The Journal of Urology ◽

10.1016/j.juro.2011.02.1265 ◽

2011 ◽

Vol 185 (4S) ◽

Author(s):

Maxine Sun ◽

Claudio Jeldres ◽

Firas Abdollah ◽

Monica Morgan ◽

Jan Schmitges ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Length Of Stay ◽

Hospital Mortality ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Hospital Volume ◽

Surgery Complications ◽

Type Of Surgery

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Trends in Hospital Cost, Length of Stay, Mortality, and Complication Rates in Patients with Acute Myeloid Leukemia in Teaching Versus Non-Teaching Hospitals: Data from the Nationwide Inpatient Sample from 1999-2013

Blood ◽

10.1182/blood.v128.22.2357.2357 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2357-2357

Author(s):

Ankit Shah ◽

Stuthi Perimbeti ◽

Parshva Patel ◽

Rachel Nathan ◽

Daniel Kyung ◽

...

Keyword(s):

Respiratory Failure ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Marrow Transplant ◽

Neutropenic Fever ◽

Teaching Hospitals ◽

Complication Rates ◽

Total Charges ◽

Acute Myeloid

Abstract Background: Acute Myeloid Leukemia (AML) is the most common acute leukemia in adults and represents a heterogeneous group of clonal hematopoietic stem cell disorders with varying prognosis based on cytogenetic and host factors. Success in treatment of AML is thought to have only improved modestly in recent decades. We aimed to evaluate trends in hospital cost, length of stay, in-hospital mortality, and complication rates in adult patients admitted with active AML. We also sought to elucidate differences in these outcomes in teaching versus non-teaching institutions. Methods: Using ICD-9 codes for acute myeloid and acute monocytic leukemias, all adult admissions with a primary diagnosis of active AML between 1999-2013 were identified from the Nationwide Inpatient Sample (NIS). Admission information including length of stay (LOS), total charges, and mortality were extracted. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. ICD-9 codes were selected to reflect the most common etiologies of in-hospital complications such as clostridium difficile infection (CDI), bacteremia, sepsis, pneumonia, venous thromboembolism (VTE), neutropenic fever, candidiasis, urinary tract infection (UTI), and acute respiratory failure. Rates of these complications were determined over the 15-year interval and compared in subsets of teaching and non-teaching hospitals. Rates of bone marrow transplant were also queried. Results: We identified 51,684 admissions (weighted N = 247,747) with a primary diagnosis of AML from 1999-2013. Most of the admissions were at teaching hospitals (N = 32,982; weighted N = 158,952). Overall in-hospital mortality was determined to be 19.54%. LOS (days) was found to be longer in teaching (21.04 ±0.10) than in non-teaching (12.25 ±0.11) hospitals (p = .0001). Total charges were also greater in teaching ($157,709 ±1,089) versus non-teaching ($79,167 ±965) hospitals (p = .0001). Of note, after correcting for age, multivariate analysis yielded higher mortality in teaching than in non-teaching hospitals (OR = 1.11, CI: 1.04-1.19). Rates of CDI, bacteremia, neutropenic fever, sepsis, acute respiratory failure, and VTE were higher in teaching hospitals (p < .0001). On the other hand, rates of UTI were lower in teaching (7.31%) than in non-teaching (8.31%) hospitals (p=.0026). Rates of pneumonia and candidiasis did not have a statistically significant difference when comparing the two settings. Bone marrow transplant was more frequently performed at teaching (1.36%) than in non-teaching hospitals (0.56%) (p=.0001). Over the 15-year interval, in-hospital mortality has declined by greater than one third for all AML admissions (p <. 0001). Rates of nearly all of the complications, excluding candidiasis, but including CDI, neutropenic fever, bacteremia, UTI, pneumonia, VTE, and acute respiratory failure have increased during this interval, however. Total charges increased during this time period from $66,678 (±1,567) in 1999 to $197,439 (±4,532) in 2013 (p = .0001), which was greater than the expected inflationary increase to $93,235 over the same time period. Conclusions: Most admissions for AML occurred at teaching institutions. This may be due to increased resource requirements to care for this patient population. In-hospital mortality appears to have improved markedly from 1999-2013 for all admissions for AML, which may be a testament to well-established chemotherapy guidelines, use of less toxic chemotherapy regimens in the elderly, and standardized preventative practices such as the use of high-efficiency particulate air filtration and prophylactic antibiotics. On the other hand, rates of nearly all measured complications have increased during this interval. Given the opposite trend in mortality, we believe this may be in part due to improved surveillance and reporting. Rates of mortality as well several complication rates appear to be higher in teaching than in non-teaching institutions, which may be due to increased medical complexity and more aggressive therapy offered at teaching institutions. Further research is required to determine what additional factors and practice differences are contributing to these discrepancies. Total charges were higher at teaching institutions, which may be due to increased LOS, complication rates, medical complexity and resource consumption. Disclosures No relevant conflicts of interest to declare.

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