scholarly journals Nationwide in‐hospital mortality following colonic cancer resection according to hospital volume in Germany

BJS Open ◽  
2019 ◽  
Vol 3 (5) ◽  
pp. 672-677 ◽  
Author(s):  
J. Diers ◽  
J. Wagner ◽  
P. Baum ◽  
S. Lichthardt ◽  
C. Kastner ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Volume ◽  
Colonic Cancer ◽  
Cancer Resection

Impact of hospital type and surgical volume on outcomes of biliary cancer resection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16168-e16168
Author(s):  
Jasmeet Kaur ◽  
Waqas Qureshi ◽  
Vaibhav Sahai
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Healthcare Cost ◽  
Hospital Volume ◽  
Teaching Hospitals ◽  
Biliary Cancer ◽  
Cancer Resection ◽  
Operative Complications ◽  
Teaching Status ◽  
Post Operative Complications

e16168 Background: The mainstay of treatment for patients with early-stage biliary cancer (gallbladder or cholangiocarcinoma) is surgical resection. Herein, we evaluated the predictors for biliary cancer resection outcome and association with hospital volume and teaching status. Methods: A national representative cohort of 18485 biliary cancer patients was included for the years 2016 – 2018 from the national inpatient sample database. The study population included patients ≥ 18 years diagnosed with biliary cancer who underwent elective surgical resection (ICD 10). Hospitals were categorized based on teaching status (yes, if ACGME approved residency program, member of the council of teaching hospitals, or with residents to beds ratio of .25 or higher, versus non-teaching); and hospital volume (high if ≥ 20 biliary cancer surgeries performed per year, otherwise low). The primary outcome was biliary resection and the secondary outcomes included post-operative complications, in-hospital mortality, length of stay (< or ≥ 7 days), and health care cost (< or ≥ median) based on hospital teaching status and biliary cancer surgical volume. Association with outcomes was assessed using multivariable logistic regression models adjusted for age, sex, race, household income, service payer, Elixhauser co-morbidity score, hospital volume, teaching status, bed size, location, and region. Results: Out of 18,485 patients hospitalized with biliary cancer, 7,030 patients underwent elective biliary cancer resection during the study period. Patients undergoing resection were likely to have higher than national household median income with Medicare as primary insurance payor. In multivariate adjusted logistic regression models, high volume centers showed significantly lower length of stay (adjusted odds ratio (aOR) 0.73; 95% CI 0.54 - 0.97; p=0.03), and lower in-hospital mortality (aOR 0.28; 95% CI 0.15 - 0.80; p=0.01), but no significant difference in post-operative complications or healthcare cost compared to low volume centers. Surgeries performed in a teaching hospital were associated with decreased risk of post-operative complications (aOR 0.74; 95% CI 0.55 - 1.0; p=0.05), significant decrease in in-hospital mortality (aOR 0.44; 95% CI 0.27 - 0.69; p=0.001), but higher inflation-adjusted healthcare cost (aOR 1.77; 95% CI 1.37-2.26; p<0.001) with no difference in length of stay. Conclusions: Patients who underwent elective biliary cancer surgery at a teaching or high-volume hospital had a significant decrease in their risk of in-hospital mortality. Additionally, surgeries at teaching hospitals were associated with a significantly lower post-operative complication rate compared to similar procedures at a non-teaching hospital, although teaching hospitals did have a significantly higher healthcare cost when adjusted for length of stay.

Darmkrebs-OP: Auf die Erfahrung kommt es an

2020 ◽  
Vol 52 (04) ◽  
pp. 162-164
Author(s):  
Frank Lichert
Keyword(s):  
Rectal Cancer ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Volume ◽  
Rectum Resection

Diers J et al. Nationwide in-hospital mortality rate following rectum resection for rectal cancer according to annual hospital volume in Germany. BJS Open 2020; doi:10.1002/bjs5.50254

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.”

Hospital volumes and the likelihood of stent implantation among patients undergoing catheterization of the left heart: more is more?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Oettinger ◽  
M Zehender ◽  
C Von Zur Muehlen ◽  
C Bode ◽  
K Kaier ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Stent Implantation ◽  
Hospital Volume ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Artery Disease ◽  
Documented Coronary Artery Disease

Abstract Background Percutaneous coronary intervention (PCI) is an established procedure, but recent studies analyzing the indication for stenting are going to change clinical practice. Previous studies suggested that hospital volume is inversely related to in-hospital mortality but its impact on likelihood of stent implantation and the number of stents remains unclear. Purpose There is a conflict of objectives between nationwide care including short transfer and intervention times and a few large centers with maximum technology and experience. We examine the effect of hospital volume on in-hospital mortality, likelihood of stent implantation, number of stents, length of hospital stay, and reimbursement in a recent nationwide cohort from Germany. Methods Using German national electronic health records, all patients who underwent coronary angiography with a documented coronary artery disease were identified by ICD and OPS codes. Risk-adjustment was applied using a predefined set of patient characteristics to account for differences in the risk factor composition of the patient populations between centers. Results In 2017, a total of 528,188 patients with a documented coronary artery disease underwent coronary angiography in Germany. Mean age was 69.8 years and 29.3% of patients were female. 55% of all patients received PCI, with a mean number of 1.01 stents implanted per patient. In-hospital mortality was 2.9%, length of hospital stay was 6.5 days and mean reimbursement was €5,531. Multivariable regression analyses showed a positive linear association between hospital volumes and the likelihood of stent implantation (p=0.003) as well as the number of implanted stents (p=0.020). No association was found between hospital volumes and in-hospital mortality (p=0.105), length of hospital stay (p=0.201) or reimbursement (p=0.108). Inspection of the non-linear impact of procedure volumes on stent implantation practices indicates a ceiling effect in the volume-outcome relationship: implantation likelihood and number of stents per patient are lowest in centers with less than 100 procedures per year (34.4% and 0.62, respectively). Then, implantation likelihood and number of stents constantly increase until the volume category of 500 procedures per year and center. For centers with &gt;500 procedures per year, the likelihood of stent implantation and the number of implanted stents remained relatively constant (about 60% and 1.07, respectively). Conclusion Patients undergoing coronary angiography in low-volume centers are less frequently subject to PCI but at comparable risk for in-hospital mortality. Furthermore, the data suggest that more complex cases are treated in high volume centers with consistent mortality rates and thus constant safety is ensured in high volume hospitals. Thresholds are discussed. Impact of hospital volumes on PCI Funding Acknowledgement Type of funding source: None

Effect of Hospital Volume and Regionalization of Care in Patients Undergoing Pancreatic Cancer Resection: A Propensity-Score Matched Analysis

2019 ◽  
Vol 229 (4) ◽  
pp. S172-S173
Author(s):  
Jose Wilson B. Mesquita-Neto ◽  
Peter Cmorej ◽  
Awni Shahait ◽  
Steve Kim ◽  
Donald W. Weaver ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Propensity Score ◽  
Hospital Volume ◽  
Cancer Resection ◽  
Regionalization Of Care

scholarly journals In-hospital mortality after stomach cancer surgery in Spain and relationship with hospital volume of interventions

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Marisa Baré ◽  
Joan Cabrol ◽  
Jordi Real ◽  
Gemma Navarro ◽  
Rafel Campo ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Stomach Cancer ◽  
Hospital Volume ◽  
Cancer Surgery
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