Relationship between hospital surgical volume, lobectomy rates, and adverse perioperative events at US epilepsy centers

Object Epilepsy surgery remains significantly underutilized. The authors recently reported that the number of lobectomies for localized intractable epilepsy in the US has not changed despite the implementation of clear evidence-based guidelines 10 years ago supporting early referral for surgery. To better understand why epilepsy surgery continues to be underused, the authors' objective was to carefully examine hospital-related factors related to the following: 1) where patients are being admitted for the evaluation of epilepsy, 2) rates of utilization for surgery across hospitals, and 3) perioperative morbidity between hospitals with low versus high volumes of epilepsy surgery. Methods The authors performed a population-based cohort study of US hospitals between 1990 and 2008 using the Nationwide Inpatient Sample (NIS), stratifying epilepsy surgery rates and trends as well as perioperative morbidity rates by hospital surgical volume. Results The number of lobectomies for epilepsy performed at high-volume centers (> 15 lobectomies/year) significantly decreased between 1990 and 2008 (F = 20.4, p < 0.001), while significantly more procedures were performed at middle-volume hospitals (5–15 lobectomies/year) over time (F = 16.1, p < 0.001). No time trend was observed for hospitals performing fewer than 5 procedures per year. However, patients admitted to high-volume centers were significantly more likely to receive lobectomy than those at low-volume hospitals (relative risk 1.05, 95% CI 1.03–1.08, p < 0.001). Also, the incidence of perioperative adverse events was significantly higher at low-volume hospitals (12.9%) than at high-volume centers (6.1%) (relative risk 1.08, 95% CI 1.03–1.07, p < 0.001). Conclusions Hospital volume is an important predictor of epilepsy surgery utilization and perioperative morbidity. Patients with medically refractory epilepsy should be referred to a comprehensive epilepsy treatment center for surgical evaluation by an experienced clinical team.

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Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery

World Journal of Surgery ◽

10.1007/s00268-021-06296-w ◽

2021 ◽

Author(s):

Miriam Lillo-Felipe ◽

Rebecka Ahl Hulme ◽

Maximilian Peter Forssten ◽

Gary A. Bass ◽

Yang Cao ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

High Volume ◽

Cancer Surgery ◽

Colon And Rectal Surgery ◽

Surgical Volume ◽

Failure To Rescue ◽

Colorectal Cancer Surgery ◽

Procedure Volume ◽

Low Volume

Abstract Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

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Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

Neuro-Oncology Practice ◽

10.1093/nop/npu021 ◽

2014 ◽

Vol 1 (4) ◽

pp. 166-171 ◽

Cited By ~ 7

Author(s):

Alba A. Brandes ◽

Enrico Franceschi ◽

Mario Ermani ◽

Alicia Tosoni ◽

Fiorenzo Albani ◽

...

Keyword(s):

Methylation Status ◽

High Volume ◽

Population Based ◽

Phase Iii ◽

Treatment Center ◽

Current Standard ◽

Pattern Of Care ◽

Phase Iii Trials ◽

Emilia Romagna Region ◽

High Volume Center

Abstract Background As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. Methods Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. Results Two hundred sixty-seven GBM patients (median age, 64 y; range, 29–84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2–12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0–18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248–0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388–0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328–0.986; P = .0446). Conclusions The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.

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Likelihood of high volume renal surgeons to offer elective partial nephrectomy in high complexity tumors as classified by the nephrometry scoring system.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.354 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 354-354

Author(s):

C. J. Weight ◽

S. P. Kim ◽

P. L. Crispen ◽

R. H. Breau ◽

S. A. Boorjian ◽

...

Keyword(s):

Partial Nephrectomy ◽

Scoring System ◽

Radical Nephrectomy ◽

High Volume ◽

Low Complexity ◽

Surgical Volume ◽

High Complexity ◽

Renal Masses ◽

Clinical Scenarios ◽

Low Volume

354 Background: Partial nephrectomy (PN) has demonstrated equivalent cancer control to radical nephrectomy (RN) and has been associated with lower rates of all-cause mortality. Nevertheless, there continues to be wide variability in practice pattern in the treatment of renal masses. Specifically, the decision to perform PN or RN often depends on patient, surgeon and renal mass characteristics. By quantifying the renal tumor using the R.E.N.A.L. nephrometry scoring system, collecting surgeon information, and providing defined clinical scenarios we attempt to evaluate factors important in surgeon decision-making. Methods: In June 2009, all members of the American Urological Association with a listed email address were invited to participate in a survey evaluating the management of renal masses. Respondents were asked their preferred treatment for 8 clinical scenarios. Each of these renal masses was given a nephrometry score (NS). The propensity to offer PN was evaluated by NS and surgical volume. High volume was defined as > 50 renal cases per year and low volume was defined as £ 10 cases per year. Results: 764 attending level urologic surgeons responded to each of the 8 scenarios providing 6112 evaluable clinical scenarios. NS ranged from 4-10; each unit increase was associated with 2-fold increased odds of a surgeon offering radical nephrectomy (OR 1.99, 95% CI: 1.93,2.06). PN was the preferred treatment for approximately 95% of patients with low complexity tumors (NS < 8) regardless of surgical volume. However, proposed treatment of high complexity tumors (NS ³ 8) demonstrated considerable heterogeneity in treatment choice. Controlling for all patient characteristics, high surgical volume significantly predicted whether PN would be offered to patients with high complexity tumors (OR 3.04 95% CI: 2.34,9.95), but not those with low complexity tumors (OR 1.95 95% CI: 0.87,4.38) compared to low volume surgeons. Conclusions: Increasing NS correlated with increased use of radical nephrectomy, particularly after a score of 8 among all surgeons. As renal surgical volume increased, surgeons were more willing to offer PN in high complexity tumors. No significant financial relationships to disclose.

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Esophagectomy in the State of Florida: Is Regionalization of Care Warranted?

The American Surgeon ◽

10.1177/000313481207800335 ◽

2012 ◽

Vol 78 (3) ◽

pp. 291-295 ◽

Cited By ~ 4

Author(s):

Kfir Ben-David ◽

Darwin Ang ◽

Stephen R. Grobmyer ◽

Huazhi Liu ◽

Tad Kim ◽

...

Keyword(s):

Health Care Administration ◽

Postoperative Mortality ◽

High Volume ◽

Population Based ◽

Care Needs ◽

Population Based Study ◽

Time Period ◽

Low Volume ◽

Regionalization Of Care ◽

Related Mortality

Centralization of cancer care needs to be based on evidence that regionalization will improve outcomes in a given region. We analyzed outcomes for esophagectomy performed in Florida using the Agency for Health Care Administration database. We determined the risk-adjusted mortality rate for the procedure in low-volume and high-volume centers. From 1997 to 2006, 991 esophagectomies were performed in Florida. The incidence of esophagectomy significantly increased from 1997 to 2001 compared with 2002 to 2006, and the postoperative mortality decreased in the latter time period (odds ratio [OR], 1.87; confidence interval [CI], 1.16–3.03). The risk-adjusted postoperative mortality was significantly lower (OR, 0.54; CI, 0.32–0.92) in high-volume centers (5.1 vs 10.4%). The anastomotic leak rates were 8.2 per cent in both high- and low-volume centers. In the largest population-based study for esophagectomy in Florida, outcomes are better in high-volume centers. These data support the regionalization of esophagectomy to high-volume locations in Florida to reduce procedure-related mortality.

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Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study

Journal of Clinical Oncology ◽

10.1200/jco.2004.04.172 ◽

2004 ◽

Vol 22 (1) ◽

pp. 166-174 ◽

Cited By ~ 103

Author(s):

Jeffrey A. Meyerhardt ◽

Joel E. Tepper ◽

Donna Niedzwiecki ◽

Donna R. Hollis ◽

Deborah Schrag ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Cancer Recurrence ◽

High Volume ◽

Adjuvant Chemoradiotherapy ◽

Surgical Volume ◽

Significant Difference ◽

Rectal Cancer Recurrence ◽

Procedure Volume ◽

Low Volume

Purpose Prior studies have demonstrated superior outcomes after a curative surgical resection of rectal cancer at hospitals where the volume of such surgeries is high. However, because these studies often lack detailed information on tumor and treatment characteristics as well as cancer recurrence, the true nature of this relation remains uncertain. Patients and Methods We studied a nested cohort of 1,330 patients with stage II and stage III rectal cancer participating in a multicenter, adjuvant chemoradiotherapy trial. We analyzed differences in rates of sphincter-preserving operations, overall survival, and cancer recurrence by hospital surgical volume. Results We observed a significant difference in the rates of abdominoperineal resections across tertiles of hospital procedure volume (46.3% for patients resected at low-volume, 41.3% at medium-volume, and 31.8% at high-volume hospitals; P < .0001), even after adjustment for tumor distance from the anal verge. However, this higher rate of sphincter-sparing operations at high-volume centers was not accompanied by any increase in recurrence rates. Hospital surgical volume did not predict overall, disease-free, recurrence-free, or local recurrence-free survival. However, among patients who did not complete the planned adjuvant chemoradiotherapy (270 patients), those who underwent surgery at low-volume hospitals had a significant increase in cancer recurrence (adjusted hazard ratio, 1.94; 95% CI, 1.01 to 3.72; P = .04 for the trend) and a nonsignificant trend toward increased overall mortality (P = .08) and local recurrence (P = .10). In contrast, no significant volume-outcome relation was noted among patients who did complete postoperative therapy. Conclusion Using prospectively recorded data, we found that hospital surgical volume had no significant effect on rectal cancer recurrence or survival when patients completed standard adjuvant therapy. Sphincter-preserving surgery was more commonly performed at high-volume centers.

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

BMJ Open ◽

10.1136/bmjopen-2019-032183 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032183 ◽

Cited By ~ 7

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.

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The Effect of Laparoscopic Radical Hysterectomy Surgical Volume on Oncology Outcomes in Early-Stage Cervical Cancer

Frontiers in Surgery ◽

10.3389/fsurg.2021.692163 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pengfei Li ◽

Jiaqi Liu ◽

Li Wang ◽

Shang Kang ◽

Ying Yang ◽

...

Keyword(s):

Cervical Cancer ◽

Blood Loss ◽

Radical Hysterectomy ◽

Multivariable Analysis ◽

High Volume ◽

Surgical Volume ◽

Laparoscopic Radical Hysterectomy ◽

Oncological Outcomes ◽

Volume Group ◽

Low Volume

Purpose: To examine the association between surgical volume and surgical and oncological outcomes of women with stage IB1 cervical cancer who underwent laparoscopic radical hysterectomy (LRH).Methods: We retrospectively analyzed the oncological outcomes of 1,137 patients with stage IB1 cervical cancer receiving LRH from 2004 to 2016. The surgical volume for each surgeon was defined as low [fewer than 50 surgeries, n = 392(34.5%)], mid [51-100 surgeries, n = 315(27.7%)], and high [100 surgeries or more, n = 430(37.8%)]. Surgical volume-specific survival was examined with Kaplan–Meier analysis, multivariable analysis, and propensity score matching.Results: The operative times of the high-volume group (227.35 ± 7.796 min) were significantly shorter than that of the low- (272.77 ± 4.887 min, p < 0.001) and mid-volume (255.86 ± 4.981 min, p < 0.001) groups. Blood loss in the high-volume group (169.42 ± 8.714 ml) was significantly less than that in the low-volume group (219.24 ± 11.299 ml, p = 0.003). The 5-year disease-free survival (DFS) and overall survival (OS) in the low-volume, mid-volume, and high-volume groups were similar (DFS: 91.9, 86.7, and 89.2%, p = 0.102; OS: 96.4, 93.5, and 94.2%, p = 0.192). Multivariable analysis revealed surgical volume was not an independent risk factor for OS or DFS. The rate of intraoperative and postoperative complications was similar among the three groups (p = 0.210).Conclusions: Surgical volume of LRH may not be a prognostic factor for patients with stage IB1 cervical cancer. Surgery at high-volume surgeon is associated with decreased operative time and blood loss.

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Economic impacts of care by high-volume providers for noncurative esophagogastric cancer: A population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.339 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 339-339

Author(s):

Julie Hallet ◽

Nicole Look Hong ◽

Victoria Zuk ◽

Laura Davis ◽

Vaibhav Gupta ◽

...

Keyword(s):

Cost Effectiveness ◽

Healthcare Costs ◽

Care Delivery ◽

High Volume ◽

Population Based ◽

Dominant Strategy ◽

Sensitivity Analyses ◽

Esophagogastric Cancer ◽

Effectiveness Of Care ◽

Low Volume

339 Background: Esophagogastric cancer (EGC) is one of the deadliest and costliest malignancies to treat. Care by high-volume providers can provide better outcomes for patients with EGC. Cost implications of volume-based cancer care are unclear. We examined the cost-effectiveness of care by high-volume medical oncology providers for non-curative management of EGC. Methods: We conducted a population-based cohort study of non-curative EGC over 2005-2017 by linking administrative healthcare datasets. High-volume was defined as >11 patients/provider/year. Healthcare costs ($USD/patient/month-survived) were computed from diagnosis to death or end of follow-up from the perspective of the healthcare system using validated costing algorithms. Multivariable quantile regression examined the association between care by high-volume providers and costs. Sensitivity analyses were conducted by varying costing horizons and high-volume definitions. Results: Among 7,011 non-curative EGC patients, median overall survival was superior with care by high-volume providers with 7.0 (IQR: 3.3-13.3) compared to 5.9 (IQR: 2.6-12.1) months (p < 0.001) for low-volume providers. Median costs/patient/month-lived were lower for high-volume providers ($5,518 vs. $5,911; p < 0.001), owing to lower inpatient acute care costs, despite higher medication-associated and radiotherapy costs. Care by high-volume providers was independently associated with a reduction of $599 per patient/month-lived (95% confidence interval: -966 to -331) compared to low-volume providers. The incremental cost-effectiveness ratio was -393. Care by high-volume providers remained the dominant strategy when varying the high-volume definition and the costing time horizon. Conclusions: Care by high-volume providers for non-curative EGC is associated with superior survival and lower healthcare costs, indicating a dominant strategy that may provide an opportunity to improve cost-effectiveness of care delivery.

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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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