scholarly journals In-hospital Mortality and Failure to Rescue Following Hepatobiliary Surgery in Germany - A Nationwide Analysis.

2020 ◽  
Author(s):  
Christian Krautz ◽  
Christine Gall ◽  
Olaf Gefeller ◽  
Ulrike Nimptsch ◽  
Thomas Mansky ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Volume ◽  
High Volume ◽  
Hepatobiliary Surgery ◽  
Failure To Rescue ◽  
Volume Outcome ◽  
Low Volume ◽  
Very High ◽  
Overall Mortality

Abstract Background: Recent observational studies on volume-outcome associations in hepatobiliary surgery were not designed to account for the varying extent of hepatobiliary resections and the consequential risk of perioperative morbidity and mortality. Therefore, this study aimed to determine the risk-adjusted in-hospital mortality for minor and major hepatobiliary resections at the national level in Germany and to examine the effect of hospital volume on in-hospital mortality, and failure to rescue. Methods: All inpatient cases of hepatobiliary surgery (n = 31,114) in Germany from 2009 to 2015 were studied using national hospital discharge data. After ranking hospitals according to increasing hospital volumes, five volume categories were established based on all hepatobiliary resections. The association between hospital volume and in-hospital mortality following minor and major hepatobiliary resections was evaluated by multivariable regression methods. Results: Minor hepatobiliary resections were associated with an overall mortality rate of 3.9% and showed no significant volume-outcome associations. In contrast, overall mortality rate of major hepatobiliary resections was 10.3%. In this cohort, risk-adjusted in-hospital mortality following major resections varied widely across hospital volume categories, from 11.4% (95% CI 10.4–12.5) in very low volume hospitals to 7.4% (95% CI 6.6–8.2) in very high volume hospitals (risk-adjusted OR 0.59, 95% CI 0.41–0.54). Moreover, rates of failure to rescue decreased from 29.38% (95% CI 26.7-32.2) in very low volume hospitals to 21.38% (95% CI 19.2-23.8) in very high volume hospitals. Conclusions: In Germany, patients who are undergoing major hepatobiliary resections have improved outcomes, if they are admitted to higher volume hospitals. However, such associations are not evident following minor hepatobiliary resections. Following major hepatobiliary resections, 70-80% of the excess mortality of the very low volume hospitals was estimated to be attributable to failure to rescue.

scholarly journals In-hospital Mortality and Failure to Rescue Following Hepatobiliary Surgery in Germany - A Nationwide Analysis.

2019 ◽  
Author(s):  
Christian Krautz ◽  
Christine Gall ◽  
Olaf Gefeller ◽  
Ulrike Nimptsch ◽  
Thomas Mansky ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Volume ◽  
High Volume ◽  
Hepatobiliary Surgery ◽  
Failure To Rescue ◽  
Discharge Data ◽  
Low Volume ◽  
Very High ◽  
Overall Mortality

Abstract Objective To determine the risk-adjusted in-hospital mortality for hepatobiliary resections at the national level in Germany and to examine the effect of hospital volume on in-hospital mortality, and failure to rescue. Summary Background Data There is a paucity of population-based outcome data on hepatobiliary surgery in European countries, including Germany. Methods We studied all inpatient cases of hepatobiliary surgery (n = 31,114) in Germany from 2009 to 2015, using national hospital discharge data. After ranking hospitals according to increasing hospital volumes, five volume categories were established based on all hepatobiliary resections. We evaluated the association between hospital volume and in-hospital mortality following minor and major hepatobiliary resections by using multivariable regression methods. Results Minor hepatobiliary resections were associated with an overall mortality rate of 3.9% and showed no significant volume-outcome associations. In contrast, overall mortality rate of major hepatobiliary resections was 10.3%. In this cohort, risk-adjusted in-hospital mortality following major resections varied widely across hospital volume categories, from 11.4% (95% CI 10.4–12.5) in very low volume hospitals to 7.4% (95% CI 6.6–8.2) in very high volume hospitals (risk-adjusted OR 0.59, 95% CI 0.41–0.54). Moreover, rates of failure to rescue decreased from 29.38% (95% CI 26.7-32.2) in very low volume hospitals to 21.38% (95% CI 19.2-23.8) in very high volume hospitals. Conclusions In Germany, patients who are undergoing major hepatobiliary resections have improved outcomes if they are admitted to higher volume hospitals. Given the high rates of nationwide in-hospital mortality, health political strategies to initiate a sufficient centralization process of major hepatobiliary surgery in Germany are needed.

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 High Subarachnoid Hemorrhage Patient Volume Associated With Lower Mortality and Better Outcomes

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 462-470 ◽  
Author(s):  
Aditya S. Pandey ◽  
Joseph J. Gemmete ◽  
Thomas J. Wilson ◽  
Neeraj Chaudhary ◽  
B. Gregory Thompson ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Temporal Trends ◽  
High Volume ◽  
Patient Volume ◽  
Inpatient Mortality ◽  
Discharge Home ◽  
Volume Outcome ◽  
Low Volume ◽  
Aggressive Care

Abstract BACKGROUND: High-volume centers have better outcomes than low-volume centers when managing complex conditions including subarachnoid hemorrhage (SAH). OBJECTIVE: To quantify SAH volume-outcome association and determine the extent to which this association is influenced by aggressiveness of care. METHODS: A serial cross-sectional retrospective study using the Nationwide Inpatient Sample for 2002 to 2010 was performed. Included were all adult (older than 18 years of age) discharged patients with a primary diagnosis of SAH admitted from the emergency department or transferred to a discharging hospital; cases of trauma or arteriovenous malformation were excluded. Survey-weighted descriptive statistics estimated temporal trends. Multilevel logistic regression estimated volume-outcome associations for inpatient mortality and discharge home. Models were adjusted for demographic characteristics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and all patient-refined, diagnosis-related group mortality. Analyses were repeated, excluding cases in which aggressive care was not pursued. RESULTS: A total of 32 336 discharges were included; 13 398 patients underwent clipping (59.1%) or coiling (40.9%). The inpatient mortality rate decreased from 32.2% in 2002 to 22.2% in 2010; discharge home increased from 28.5% to 40.8% during the same period. As SAH volume decreased from 100/year, the mortality rate increased from 18.7% to 19.8% at 80/year, 21.7% at 60/year, 24.5% at 40/year, and 28.4% at 20/year. As SAH patient volume decreased, the probability of discharge home decreased from 40.3% at 100/year to 38.7% at 60/year, and 35.3% at 20/year. Better outcomes persisted in patients receiving aggressive care and in those not receiving aggressive care. CONCLUSION: Short-term SAH outcomes have improved. High-volume hospitals have more favorable outcomes than low-volume hospitals. This effect is substantial, even for hospitals conventionally classified as high volume.

Hospital-Volume Effects on Perioperative Outcomes in Peritoneal Dialysis Catheter Implantation: Analysis of 2,505 Cases

2018 ◽  
Vol 38 (6) ◽  
pp. 419-423 ◽  
Author(s):  
Yoshitaka Kinoshita ◽  
Toru Sugihara ◽  
Hideo Yasunaga ◽  
Hiroki Matsui ◽  
Akira Ishikawa ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Adverse Events ◽  
Hospital Volume ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Peritoneal Dialysis Catheter ◽  
Volume Outcome ◽  
Catheter Implantation ◽  
Low Volume

Background Evidence regarding volume-outcome effects on peritoneal dialysis (PD) catheter implantation is limited. This study aimed to investigate associations between hospital volume (annual caseload of catheter implantation) and perioperative outcomes. Methods Clinical data for patients who underwent PD catheter implantation from 2007 to 2012 were extracted from the Japanese nationwide Diagnosis Procedure Combination database. Hospital volume was divided into tertiles: low-volume (1 – 6 cases/year), medium-volume (7 – 13 cases/year), and high-volume (≥ 14 cases/year). Multivariate logistic regression analysis for the occurrence of any adverse events and blood transfusion, and gamma-distributed log-linked linear regression analysis for postoperative length of stay were conducted with explanatory variables of hospital volume, age, sex, Charlson comorbidity index, history of hemodialysis, type of anesthesia, and type of hospital. Results Among 906, 855, and 744 cases in the low-volume, medium-volume, and high-volume groups, overall adverse events were 10.0%, 7.6%, and 6.0%, transfusion rates were 1.3%, 1.1%, and 0.9%, and median postoperative stays were 12, 10, and 9 days, respectively. In multivariate analyses, compared with the low-volume group, medium-volume and high-volume groups were associated with a lower incidence of overall adverse events (odds ratio [OR] = 0.71, p = 0.058, and OR = 0.59, p = 0.013, respectively) and shorter postoperative stay (% difference = -10.5%, p = 0.023, and % difference = -18.5%, p = 0.001, respectively), while no significant association was detected for transfusion. Conclusions Less frequent adverse events and shorter stays were observed in higher-volume centers. Inverse volume-outcome relationships in PD catheter implantation were confirmed.

scholarly journals Impact of hospital volume on in-hospital mortality and 30-day cardiac readmission of hospitalized patients with heart faliure. A population based study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.L Bonilla Palomas ◽  
M.P Anguita-Sanchez ◽  
F.J Elola ◽  
J.L Bernal ◽  
C Fernandez-Perez ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Regression Models ◽  
Hospital Volume ◽  
Clustering Algorithm ◽  
Pearson Correlation ◽  
High Volume ◽  
Hospitalized Patients ◽  
Data Set ◽  
High Volume Hospital ◽  
Low Volume

Abstract Background Heart failure (HF) is a major health care problem. Epidemiological data from hospitalized patients are scarce and the association between hospital volume and patient outcomes is largely unknown. Purpose The aim of this study was to analyze the relationship between hospital volume and outcomes (in-hospital mortality and 30-day cardiac readmission). Methods We conducted an observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) within 30 days after discharge by using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Information on the number of HF discharges at each hospital in 2015 was analysed to classify centres into 2 categories (high- and low-volume hospitals). To discriminate between high- and low-volume centers, a K-means clustering algorithm was used. The association between volume and RSMR or RSRR was tested with the Pearson correlation coefficient and linear regression models. Results A total of 117 233 episodes of HF were selected during 2015. The mean age was 80±10 years and 46% were women. The crude in-hospital mortality rate was 12.1% and 30-day cardiac readmission rate was 18%. The cut-off point was set at 517 HF discharges per hospital during 2015. High volume hospitals had a statistically lower RSMR (10.3±2.8 vs 11.3±3.6; p&lt;0.001) and higher RSRR (10.7±1.9 vs 9.2±1.6; p&lt;0.001) than low volume hospitals. Low-volume hospitals showed higher dispersion of outcomes than high-volume, both for RSMR and RSRR (Figure). Conclusions We found that patients hospitalized for HF in 2105 had lower in-hospital mortality if they were admitted to a high-volume hospital. We have also found that high-volume hospitals had higher 30-day cardiac readmission rates. Funding Acknowledgement Type of funding source: None

scholarly journals Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032183 ◽  
Author(s):  
Deirdre M Nally ◽  
Jan Sørensen ◽  
Gintare Valentelyte ◽  
Laura Hammond ◽  
Deborah McNamara ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Abdominal Surgery ◽  
Hospital Mortality ◽  
High Volume ◽  
Population Based ◽  
Publicly Funded ◽  
Population Based Study ◽  
Low Volume ◽  
Surgical Teams ◽  
Emergency Abdominal Surgery

​ObjectivesEmergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level.​DesignThis is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland.​Setting24 public hospitals providing EAS services.​Participants and InterventionsPatients undergoing EAS as identified by primary procedure codes during the period 2014–2018.​Main outcome measuresThe main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (<250), medium (250–449) and high (450+) volume and surgical teams with low (<30), medium (30–59) and high (60+) volume during the study period were also estimated.​ResultsThe study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals.​ConclusionPatients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions.

The association between hospital case volume and in-hospital and one-year mortality after hip fracture surgery

2020 ◽  
Vol 102-B (10) ◽  
pp. 1384-1391
Author(s):  
Seokha Yoo ◽  
Eun Jin Jang ◽  
Junwoo Jo ◽  
Jun Gi Jo ◽  
Seungpyo Nam ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Mortality ◽  
High Volume ◽  
Case Volume ◽  
Hospital Case ◽  
Hip Fracture Surgery ◽  
Low Volume ◽  
One Year ◽  
Fracture Surgery ◽  
Very High

Aims Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. Methods Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery. Results Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001). Conclusion Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384–1391.

Darmkrebs-OP: Auf die Erfahrung kommt es an

2020 ◽  
Vol 52 (04) ◽  
pp. 162-164
Author(s):  
Frank Lichert
Keyword(s):  
Rectal Cancer ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Volume ◽  
Rectum Resection

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

scholarly journals All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study

2021 ◽  
Author(s):  
Jawad H Butt ◽  
Emil L Fosbøl ◽  
Thomas A Gerds ◽  
Charlotte Andersson ◽  
Kristian Kragholm ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Location Of Death ◽  
All Cause Mortality ◽  
History Of ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Adjusted Incidence ◽  
Overall Mortality

Abstract Background On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures. Methods and results Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87–0.95; IRR 0.95, 95% CI 0.89–1.02; and IRR 0.87, 95% CI 0.83–0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97–1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88–0.96; out-of-hospital, IRR 1.04, 95% CI1.01–1.08). These trends were consistent irrespective of sex and age. Conclusions Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.

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