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 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.

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 Intraperitoneal extension of the peritoneal dialysis catheter—a new technique for catheter implantation in patients with obesity

2021 ◽  
Author(s):  
Michael Sayer ◽  
Christian Thiel ◽  
Martin Schenk ◽  
Alfred Königsrainer ◽  
Nils Heyne ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Circumference ◽  
Peritoneal Dialysis Catheter ◽  
Optimal Position ◽  
Catheter Survival ◽  
Surgical Access ◽  
Catheter Implantation ◽  
A New Technique ◽  
End Stage ◽  
Upper Abdomen

Abstract Background In patients with obesity and end-stage kidney disease, implantation of the peritoneal dialysis (PD) catheter may be complicated by increased abdominal circumference or skin folds. Relocation of the implantation site to the upper abdomen could solve this problem. However, this would require an extended catheter. Methods We developed an extended PD catheter based on a swan neck Missouri PD catheter with the help of two adaptors and a straight intraperitoneal extension segment. The extended catheter was assembled intraoperatively, and its length was adjusted individually to ensure correct positioning. After the operation, PD was commenced and handled as usual. Results In the period from 2011 to 2021, we implanted 31 extended PD catheters in 29 patients (38% men) with end-stage renal failure and obesity. Median age was 53 (range 28–77) years and body mass index was 35.5 (range 26.4–46.9) kg/m2. The postoperative course was unremarkable except for seroma formation in one patient and dialysate leakage in another. Continuous ambulatory peritoneal dialysis (CAPD) was initiated in 20 and APD in 9 patients. The achieved median Kt/V was 2.10 (range 1.50–3.10). During the follow-up period lasting up to 51 months, there was one case of intraperitoneal catheter disconnection due to an avoidable handling error. The peritonitis rate was 1:40 months. The 1- and 2-year catheter survival was 92% and 67%, respectively, and paralleled patient survival. Conclusions When using a PD catheter with an intraperitoneal extension, PD catheter implantation can be relocated to the upper abdomen in patients with obesity, thus providing optimal position and easy surgical access.

scholarly journals The Choice of Peritoneal Dialysis Catheter Implantation Technique by Nephrologists

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
T. Yip ◽  
S. L. Lui ◽  
W. K. Lo
Keyword(s):  
Peritoneal Dialysis ◽  
Implantation Technique ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Catheter Design ◽  
Critical Issues ◽  
Catheter Implantation ◽  
Pros And Cons ◽  
Mini Laparotomy

Peritoneal dialysis catheter (PDC) is the lifeline of peritoneal dialysis (PD) patients. One of the critical issues for successful PD is a well-functioning PDC which is timely inserted. It is the implantation technique rather than the catheter design that determines the outcome of the catheter. Dedication in acquiring the appropriate technique is vital to the success of a PD program. In this paper, we discuss the pros and cons of various techniques used for PDC implantation. A detailed description of PDC implantation by using the minilaparotomy method is presented. We strongly recommend mini-laparotomy as the method of choice for PDC implantation by nephrologists.

scholarly journals Does it matter what a hospital is “high volume” for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data

BMJ ◽  
2004 ◽  
Vol 328 (7442) ◽  
pp. 737-740 ◽  
Author(s):  
David R Urbach ◽  
Nancy N Baxter
Keyword(s):  
Odds Ratio ◽  
Surgical Procedure ◽  
Hospital Volume ◽  
Colorectal Resection ◽  
Lung Resection ◽  
Secondary Data ◽  
High Volume ◽  
The Other ◽  
Inverse Association ◽  
Volume Outcome

AbstractObjective To determine whether the improved outcome of a surgical procedure in high volume hospitals is specific to the volume of the same procedure.Design and setting Analysis of secondary data in Ontario, Canada.Participants Patients having an oesophagectomy, colorectal resection for cancer, pancreaticoduodenectomy, major lung resection for cancer, or repair of an unruptured abdominal aortic aneurysm between 1994 and 1999.Main outcome measures Odds ratio for death within 30 days of surgery in relation to the hospital volume of the same surgical procedure and the hospital volume of the other four procedures. Estimates were adjusted for age, sex, and comorbidity and accounted for hospital level clustering.Results With the exception of colorectal resection, 30 day mortality seemed to be inversely related not only to the hospital volume of the same procedure but also to the hospital volume of most of the other procedures. In some cases the effect of the volume of a different procedure was stronger than the effect of the volume of the same procedure. For example, the association of mortality from pancreaticoduodenectomy with hospital volume of lung resection (odds ratio for death in hospitals with a high volume of lung resection compared with low volume 0.36, 95% confidence interval 0.23 to 0.57) was much stronger than the association of mortality from pancreaticoduodenectomy with hospital volume of pancreaticoduodenectomy (0.76, 0.44 to 1.32).Conclusion The inverse association between high volume of procedure and risk of operative death is not specific to the volume of the procedure being studied.

scholarly journals Single staff cystectomy in a low-volume center: Oncological outcomes and complications

2021 ◽  
Vol 15 (11) ◽  
Author(s):  
Philipp Baumeister ◽  
Davide Galioto ◽  
Marco Moschini ◽  
Chiara Lonati ◽  
Stefania Zamboni ◽  
...  
Keyword(s):  
Urinary Diversion ◽  
Ileal Conduit ◽  
Perioperative Complications ◽  
Operating Time ◽  
High Volume ◽  
Median Number ◽  
Perioperative Outcomes ◽  
Limited Data ◽  
Orthotopic Neobladder ◽  
Low Volume

Introduction: Radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) is a complex surgical procedure, associated with substantial perioperative complications. Previous studies suggested reserving it to high-volume centers in order to improve oncological and perioperative outcomes. However, only limited data exist regarding low-volume centers with highly experienced surgeons. We aimed to assess oncological and perioperative outcomes after RC performed by experienced surgeons in the low-volume center of Luzerner Kantonsspital, Lucerne, CH. Methods: We retrospectively analyzed data of 158 patients who underwent RC and PLND performed between 2009 and 2019 at a single low-volume center by three experienced surgeons, each having performed at least 50 RCs. Complications were graded according to the 2004 modified Clavien-Dindo grading system. Results: A total of 110 patients (70%) received an incontinent urinary diversion (ileal conduit or ureterocutaneostomy) and 48 patients (30%) received a continent urinary diversion (ileal orthotopic neobladder, ureterosigmoidostomy, or Mitrofanoff pouch). Median operating time was 419 minutes (interquartile range [IQR] 346–461). Overall, at RC specimen, 71.5% of patients had urothelial carcinoma ,12.6% squamous, 3.1% sarcomatoid, 1.2%glandular, and 0.6% small cell carcinoma. Median number of lymph nodes removed was 23 (IQR 16–29.5). Positive margins were found in eight patients (5.1%). Overall, five-year survival rate was 52.4%. The complication rate was 56.3%: 143 complications were found in 89 patients, 36 (22.8%) with Clavien ≥3. The 30-day mortality rate was 2.5%. Conclusions: RC could be safely performed in a low-volume center by experienced surgeons with comparable outcomes to high-volume centers.

Inequal benefits from regionalization of cancer care: The pancreatic cancer surgery paradigm.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4059-4059
Author(s):  
Theodore P. McDade ◽  
Jillian K Smith ◽  
Zeling Chau ◽  
Elan R. Witkowski ◽  
James K. West ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Care ◽  
High Volume ◽  
Cancer Surgery ◽  
Perioperative Outcomes ◽  
Hospital Inpatient ◽  
Median Income ◽  
Discharge Data ◽  
Pancreatic Resections ◽  
Low Volume

4059 Background: Regionalization has been proposed for high-level care, including multidisciplinary cancer treatment and complex procedures. Pancreatic resections can serve as a marker for both. Using Massachusetts Division of Health Care Finance and Policy (DHCFP) data, we investigated regionalization of surgery for pancreatic cancer (PCa), its potential effect on perioperative outcomes, and disparities in access to high-volume PCa surgery centers. Methods: Using MA DHCFP Hospital Inpatient Discharge Data, 2005-2009, 10,524 discharges for PCa were identified, of which 746 were associated with pancreatic resection. Discharges with missing or out-of-state residence were excluded (n=704). Using geodetic methods and ZIP codes, center-to-center distances were calculated between patient (pt) and treating hospital. Median ZIP income was estimated from 2009 census data. High volume hospitals (4 of 25 performing pancreatic resections in MA) were defined using Leapfrog Criteria (> 11 per year (87th percentile for MA). Chi-square and logistic regression analyses were performed using SAS software. Results: Median age was 65. Pts were predominantly White (87.2%), with median ZIP income of $54,677. Pts travelled in-state up to 112 miles (median 15.4), with the majority resected at high volume hospitals (76%). Median length of stay (LOS) was 8.0 days, with LOS>1 week associated with low volume hospitals (p=0.0002). Of 14 in-hospital deaths, 7 were at low volume hospitals (4.14% of 169 pts) compared to 7 at high volume hospitals (1.31% of 535 pts) (p=0.0214). Predictors of shorter travel distance were: Black race (OR 4.45 (95% CI 1.66-11.93)), operation at low volume hospital (OR 2.62 (95% CI 1.81-3.77), and increased age (per year) (OR 1.02 (95% CI 1.00-1.03), but not sex or median income. Conclusions: Using MA statewide discharge data, regionalization of pancreatic cancer surgery to high-volume, better-outcome centers is seen to be occurring. However, it is not uniform, and disparities exist between groups of cancer pts that do and do not travel for their care. In the current era of scrutiny on cost, quality, and access to cancer care, further study into predictors of pts receiving optimal care is warranted.

Identifying patterns of breast cancer care provided at high volume hospitals: A classification and regression tree analysis.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 69-69
Author(s):  
Amanda L. Kong ◽  
Liliana E Pezzin ◽  
Ann B Nattinger
Keyword(s):  
Breast Cancer ◽  
Hospital Volume ◽  
Regression Tree ◽  
High Volume ◽  
Patterns Of Care ◽  
Classification And Regression Tree ◽  
Breast Cancer Care ◽  
Processes Of Care ◽  
Classification And Regression ◽  
Low Volume

69 Background: There is a growing body of literature linking hospital volume to outcomes in breast cancer. However, the mechanism through which volume influences outcome is poorly understood. The purpose of this study was to examine the relationship between hospital volume of breast cancer cases and patterns of processes of care in a population-based cohort of Medicare patients. Methods: A previously described and validated algorithm was applied to Medicare claims for newly diagnosed breast cancer cases in 2003 to identify potential subjects. Breast cancer patients were recruited to participate in a survey study examining breast cancer outcomes, and data was merged with Medicare claims and state tumor registries. Hospital volume was divided into tertiles. A Classification and Regression Tree (CART) model was performed to look for statistically significant relationships between patterns of processes of care and hospital volume. Results: Using CART analysis, eight patterns of care were identified that differentiated breast cancer care at high versus low volume hospitals. Sentinel lymph node dissection (SLND) was the single process of care that demonstrated the greatest differentiation across hospitals with differing volumes. Four patterns of care significantly predicted that a patient was less likely to be treated at a high volume hospital. Conclusions: Our study demonstrates differences in patterns of processes of care between low and high volume hospitals. Hospital volume was associated with several patterns of care that reflect the most current standards of care, particularly SLND. Greater adoption of these patterns by low volume hospitals could improve the overall quality of care for breast cancer.

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