OBJECTIVE: To compare risk- and volume-adjusted outcomes of colon resections performed at teaching hospitals (THs) vs non-THs to assess whether benign disease may influence the volume-outcome effect. DESIGN: Retrospective data analysis examining colon resections determined by International Classification of Diseases, Ninth Revision, Clinical Modification classification performed in the United States from 2001 through 2005 using the Nationwide Inpatient Sample (NIS) and the Area Resource File (2004). Patient covariates used in adjustment included age, sex, race, Charlson Index comorbidity score, and insurance status. Hospital covariates included TH status, presence of a colorectal surgery fellowship approved by the Accreditation Council for Graduate Medical Education, geographical region, institutional volume, and urban vs rural location. County-specific surgeon characteristics used in adjustment included average age of surgeons and proportion of colorectal board-certified surgeons within each county. Environmental or county covariates included median income and percentage of county residents living below the federal poverty level. SETTING: A total of 1045 hospitals located in 38 states in the United States that were included in the NIS. PATIENTS: All patients older than 18 years who had colon resection and were discharged from a hospital included in the NIS. MAIN OUTCOME MEASURES: Operative mortality, length of stay (LOS), and total charges. RESULTS: A total of 115 250 patients were identified, of whom 4371 died (3.8%). The mean LOS was 10 days. Fewer patients underwent surgical resection in THs than in non-THs (46 656 vs 68 589). Teaching hospitals were associated with increased odds of death (odds ratio, 1.14) (P = .03), increased LOS (P = .003), and a nonsignificant trend toward an increase in total charges (P = .36). CONCLUSIONS: With the inclusion of benign disease, colon surgery displays a volume-outcome relationship in favor of non-THs. Inclusion of benign disease may represent a tipping point.
OBJECTIVE: To compare risk- and volume-adjusted outcomes of colon resections performed at teaching hospitals (THs) vs non-THs to assess whether benign disease may influence the volume-outcome effect. DESIGN: Retrospective data analysis examining colon resections determined by International Classification of Diseases, Ninth Revision, Clinical Modification classification performed in the United States from 2001 through 2005 using the Nationwide Inpatient Sample (NIS) and the Area Resource File (2004). Patient covariates used in adjustment included age, sex, race, Charlson Index comorbidity score, and insurance status. Hospital covariates included TH status, presence of a colorectal surgery fellowship approved by the Accreditation Council for Graduate Medical Education, geographical region, institutional volume, and urban vs rural location. County-specific surgeon characteristics used in adjustment included average age of surgeons and proportion of colorectal board-certified surgeons within each county. Environmental or county covariates included median income and percentage of county residents living below the federal poverty level. SETTING: A total of 1045 hospitals located in 38 states in the United States that were included in the NIS. PATIENTS: All patients older than 18 years who had colon resection and were discharged from a hospital included in the NIS. MAIN OUTCOME MEASURES: Operative mortality, length of stay (LOS), and total charges. RESULTS: A total of 115 250 patients were identified, of whom 4371 died (3.8%). The mean LOS was 10 days. Fewer patients underwent surgical resection in THs than in non-THs (46 656 vs 68 589). Teaching hospitals were associated with increased odds of death (odds ratio, 1.14) (P = .03), increased LOS (P = .003), and a nonsignificant trend toward an increase in total charges (P = .36). CONCLUSIONS: With the inclusion of benign disease, colon surgery displays a volume-outcome relationship in favor of non-THs. Inclusion of benign disease may represent a tipping point.
Authors: Kevin G Billingsley; Arden M Morris; Jason A Dominitz; Barbara Matthews; Sharon Dobie; William Barlow; George E Wright; Laura-Mae Baldwin Journal: Arch Surg Date: 2007-01
Authors: Robert A Meguid; Benjamin S Brooke; David C Chang; J Timothy Sherwood; Malcolm V Brock; Stephen C Yang Journal: Ann Thorac Surg Date: 2008-03 Impact factor: 4.330
Authors: Robert A Meguid; Mark B Slidell; Christopher L Wolfgang; David C Chang; Nita Ahuja Journal: Ann Surg Oncol Date: 2008-07-12 Impact factor: 5.344
Authors: Kevin G Billingsley; Arden M Morris; Pamela Green; Jason A Dominitz; Barbara Matthews; Sharon A Dobie; William Barlow; Laura-Mae Baldwin Journal: J Am Coll Surg Date: 2008-04-14 Impact factor: 6.113
Authors: Stephanie B Wheeler; Tzy-Mey Kuo; Ravi K Goyal; Anne-Marie Meyer; Kristen Hassmiller Lich; Emily M Gillen; Seth Tyree; Carmen L Lewis; Trisha M Crutchfield; Christa E Martens; Florence Tangka; Lisa C Richardson; Michael P Pignone Journal: Health Place Date: 2014-07-24 Impact factor: 4.078
Authors: Evan M Luther; David McCarthy; Katherine M Berry; Nikhil Rajulapati; Ashish H Shah; Daniel G Eichberg; Ricardo J Komotar; Michael Ivan Journal: J Neurooncol Date: 2020-01-14 Impact factor: 4.130
Authors: Teppei Morikawa; Noriko Tanaka; Aya Kuchiba; Katsuhiko Nosho; Mai Yamauchi; Jason L Hornick; Richard S Swanson; Andrew T Chan; Jeffrey A Meyerhardt; Curtis Huttenhower; Deborah Schrag; Charles S Fuchs; Shuji Ogino Journal: Arch Surg Date: 2012-08
Authors: Bethan E Phillips; Kenneth Smith; Sarah Liptrot; Philip J Atherton; Krishna Varadhan; Michael J Rennie; Mike Larvin; Jonathan N Lund; John P Williams Journal: J Cachexia Sarcopenia Muscle Date: 2012-05-31 Impact factor: 12.910