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Surgical safety and hospital volume across a wide range of interventions.
- Source :
-
Medical care [Med Care] 2010 Nov; Vol. 48 (11), pp. 962-71. - Publication Year :
- 2010
-
Abstract
- Objectives: For certain major operations, inpatient mortality risk is lower in high-volume hospitals than those in low-volume hospitals. Extending the analysis to a broader range of interventions and outcomes is necessary before adopting policies based on minimum volume thresholds.<br />Methods: Using the United States 2004 Nationwide Inpatient Sample, we assessed the effect of intervention-specific and overall hospital volume on surgical complications, potentially avoidable reoperations, and deaths across 1.4 million interventions in 353 hospitals. Outcome variations across hospitals were analyzed through a 3-level hierarchical logistic regression model (patients, surgical interventions, and hospitals), which took into account interventions on multiple organs, 144 intervention categories, and structural hospital characteristics. Discriminative performance and calibration were good.<br />Results: Hospitals with more experience in a given intervention had similar reoperation rates but lower mortality and complication rates: odds ratio per volume deciles 0.93 and 0.97. However, the benefit was limited to heart surgery and a small number of other operations. Risks were higher for hospitals that performed more interventions overall: odds ratio per 1000 for each event was approximately 1.02. Even after adjustment for specific volume, mortality varied substantially across both high- and low-volume hospitals.<br />Conclusion: Although the link between specific volume and certain inpatient outcomes suggests that specialization might help improve surgical safety, the variable magnitude of this link and the heterogeneity of hospital effect do not support the systematic use of volume-based referrals. It may be more efficient to monitor risk-adjusted postoperative outcomes and to investigate facilities with worse than expected outcomes.
- Subjects :
- Cause of Death
Humans
Incidence
Medical Staff, Hospital statistics & numerical data
Operating Rooms statistics & numerical data
Outcome Assessment, Health Care statistics & numerical data
Registries statistics & numerical data
Surgical Procedures, Operative adverse effects
United States epidemiology
Work Schedule Tolerance
Hospital Mortality trends
Hospitals statistics & numerical data
Postoperative Complications mortality
Safety Management statistics & numerical data
Surgical Procedures, Operative statistics & numerical data
Workload statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1537-1948
- Volume :
- 48
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Medical care
- Publication Type :
- Academic Journal
- Accession number :
- 20829722
- Full Text :
- https://doi.org/10.1097/MLR.0b013e3181eaf9f6