Francisco Schlottmann1,2,3, Paula D Strassle4,5, Marco E Allaix6, Marco G Patti4,7. 1. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. fschlottmann@hotmail.com. 2. Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA. fschlottmann@hotmail.com. 3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA. fschlottmann@hotmail.com. 4. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. 5. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA. 6. Department of Surgical Sciences, University of Torino, Torino, Italy. 7. Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
Abstract
BACKGROUND: The impact of surgical volume on perioperative results after a paraesophageal hernia (PEH) repair has not yet been analyzed. We sought to characterize the trend of utilization of this procedure stratified by surgical volume in the USA, and analyze its impact on perioperative outcomes. METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥18 years old) who underwent PEH repair were included. Surgical volume was categorized as small (<6 operations/year), intermediate (6-20 operations/year), or high (>20 operations/year). Multivariable linear and logistic regression models were used to assess the effect of surgical volume on patient outcomes. RESULTS: A total of 63,812 patients were included. Over time, the rate of procedures across high-volume centers increased from 65.8 to 94.4%. The use of the laparoscopic approach was significantly different among the groups (small volume 38.4%; intermediate volume 41.8%; high volume 67.4%; p < 0.0001). Patients undergoing PEH repair at high-volume hospitals were less likely to experience postoperative bleeding, cardiac failure, respiratory failure, and shock. On average, patients at low- and intermediate-volume hospitals stayed 0.8 and 0.6 days longer, respectively. CONCLUSIONS: A spontaneous centralization towards high-volume centers for PEH repair has occurred in the last decade. This trend is beneficial for patients as it is associated with higher rates of laparoscopic operations, decreased surgical morbidity, and a shorter length of hospital stay.
BACKGROUND: The impact of surgical volume on perioperative results after a paraesophageal hernia (PEH) repair has not yet been analyzed. We sought to characterize the trend of utilization of this procedure stratified by surgical volume in the USA, and analyze its impact on perioperative outcomes. METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥18 years old) who underwent PEH repair were included. Surgical volume was categorized as small (<6 operations/year), intermediate (6-20 operations/year), or high (>20 operations/year). Multivariable linear and logistic regression models were used to assess the effect of surgical volume on patient outcomes. RESULTS: A total of 63,812 patients were included. Over time, the rate of procedures across high-volume centers increased from 65.8 to 94.4%. The use of the laparoscopic approach was significantly different among the groups (small volume 38.4%; intermediate volume 41.8%; high volume 67.4%; p < 0.0001). Patients undergoing PEH repair at high-volume hospitals were less likely to experience postoperative bleeding, cardiac failure, respiratory failure, and shock. On average, patients at low- and intermediate-volume hospitals stayed 0.8 and 0.6 days longer, respectively. CONCLUSIONS: A spontaneous centralization towards high-volume centers for PEH repair has occurred in the last decade. This trend is beneficial for patients as it is associated with higher rates of laparoscopic operations, decreased surgical morbidity, and a shorter length of hospital stay.
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