Impact of Hospital Volume on Postoperative Complications and In-Hospital Mortality After Musculoskeletal Tumor Surgery

Diers J et al. Nationwide in-hospital mortality rate following rectum resection for rectal cancer according to annual hospital volume in Germany. BJS Open 2020; doi:10.1002/bjs5.50254

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Impact of body mass index on hospital mortality and postoperative complications in a recent cohort of patients undergoing cardiac surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269143 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

PB Rahmanian ◽

A Kröner ◽

G Langebartels ◽

T Wahlers

Keyword(s):

Body Mass Index ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Hospital Mortality ◽

Body Mass ◽

Recent Cohort

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

The American Surgeon ◽

10.1177/000313481608200514 ◽

2016 ◽

Vol 82 (5) ◽

pp. 407-411 ◽

Cited By ~ 3

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.”

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National trends in Fontan operation and in-hospital outcomes in the USA

Heart ◽

10.1136/heartjnl-2018-313680 ◽

2018 ◽

Vol 105 (9) ◽

pp. 708-714 ◽

Cited By ~ 6

Author(s):

Emmanuel Akintoye ◽

William R Miranda ◽

Gruschen R Veldtman ◽

Heidi M Connolly ◽

Alexander C Egbe

Keyword(s):

Postoperative Complications ◽

Hospital Mortality ◽

Fontan Operation ◽

Disease Diagnosis ◽

Significant Decline ◽

Cardiac Complications ◽

Study Objective ◽

Number Of Patients ◽

The Usa ◽

Significant Change

BackgroundNational prevalence and outcomes of Fontan operation in the USA is unknown. Study objective was to determine trends (temporal change) in the annual volume of Fontan operations, in-hospital mortality, postoperative complications and type of hospital discharge.MethodsReview of the Nationwide Inpatient Sample for patients that underwent Fontan operation from 2001 to 2014 using the International Classification of Diseases-Ninth Revision, Clinical Modification procedure code for Fontan operation, that is, 35.94. To evaluate for change in patients’ demographics over the years, we divided the patient population into four groups based on procedure year (2001–2004, 2005–2008, 2009–2011 and 2012–2014).ResultsAn estimated 15 934 Fontan operations were performed in the USA from 2001 to 2014. Median (Q1–Q3) age was 3 (2–4) years and 39.8% were female. Hypoplastic left heart syndrome was the most common (29%) congenital heart disease diagnosis. An estimated 1175 procedures were performed in 2001 and 1340 in 2014, but there was no significant change in the number of procedures per year (p=0.47). There was significant decline in in-hospital mortality from 4.5% (53/1175) in 2001 to 1.1% (15/1340) in 2014 (p=0.009). When we compared event rates between 2001–2004 and 2012–2014 periods, there was significant decline in postoperative cardiac complications (12.6% (459/3640) to 8% (378/4706), p=0.007) and respiratory complications (17.1% (623/3640) to 10.2% (481/4706), p<0.001). However, there was increase in the number of patients discharged to home with healthcare assistance or transferred to another acute care facility (5.8% (211/3640) to 9.4% (443/4706), p=0.01) and inflation-adjusted hospitalisation cost (US$46 978 to US$60 383, p<0.001), but no significant change in length of stay (p=0.73).ConclusionOn the average, 1062 Fontan operations are performed annually in the USA with no change in volume of procedures but a decrease in in-hospital mortality and postoperative complications over a 15-year period.

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