1. Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics?
- Author
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Clark JM, Cooke DT, Hashimi H, Chin D, Utter GH, Brown LM, and Nuño M
- Subjects
- Adolescent, Adult, Aged, Comorbidity, Esophageal Neoplasms mortality, Esophagectomy mortality, Female, Florida epidemiology, Hospital Mortality, Hospitals, High-Volume, Hospitals, Low-Volume, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, New York epidemiology, Postoperative Complications epidemiology, Esophageal Neoplasms surgery, Esophagectomy statistics & numerical data, Outcome Assessment, Health Care, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objective: We examine how esophagectomy volume thresholds reflect outcomes relative to patient characteristics., Summary Background Data: Esophagectomy outcomes are associated with surgeon and hospital operative volumes, leading the Leapfrog Group to recommend minimum annual volume thresholds of 7 and 20 respectively., Methods: Patients undergoing esophagectomy for cancer were identified from the 2007-2013 New York and Florida Healthcare Cost and Utilization Project's State Inpatient Databases. Logit models adjusted for patient characteristics evaluated in-hospital mortality, complications, and prolonged length of stay (PLOS). Median surgeon and hospital volumes were compared between young-healthy (age 18-57, Elixhauser Comorbidity Index [ECI] <2) and older-sick patients (age ≥71, ECI >4)., Results: Of 4330 esophagectomy patients, 3515 (81%) were male, median age was 64 (interquartile range 58-71), and mortality was 4.0%. Patients treated by both low-volume surgeons and hospitals had the greatest mortality risk (5.0%), except in the case of older-sick patients mortality was highest at high-volume hospitals with high-volume surgeons (12%). For mortality <1%, annual hospital and surgeon volumes needed were 23 and 8, respectively; mortality rose to 4.2% when volumes dropped to the Leapfrog thresholds of 20 and 7, respectively. Complication rose from 53% to 63% when hospital and surgeon volumes decreased from 28 and 10 to 19 and 7, respectively. PLOS rose from 19% to 27% when annual hospital and surgeon volumes decreased from 27 and 8 to 20 and 7, respectively., Conclusions: Current Leapfrog Group esophagectomy volume guidelines may not predict optimal outcomes for all patients, especially at extremes of age and comorbidities., Competing Interests: The authors report no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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