Surgical safety and hospital volume across a wide range of interventions

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State: Public
Version: author
Serval ID
serval:BIB_EDB3537C5DCB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Surgical safety and hospital volume across a wide range of interventions
Journal
Medical Care
Author(s)
Eggli Yves, Halfon Patricia, Meylan Danielle, Taffé Patrick
ISSN
1537-1948[electronic], 0025-7079[linking]
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
48
Number
11
Pages
962-971
Language
english
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. 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. 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. 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.
Pubmed
Web of science
Create date
13/09/2010 11:44
Last modification date
20/08/2019 17:15
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