Elham Mahmoudi1, Yiwen Lu, Shu-Chen Chang, Chia-Yu Lin, Yi-Chun Wang, Chee Jen Chang, Ming-Huei Cheng, Kevin C Chung. 1. Ann Arbor, Mich.; and Taoyuan, Taiwan From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School; the Research Services Center for Health Information and Graduate Institute of Clinical Medicine, Chang Gung University; and the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University.
Abstract
BACKGROUND: Greater hospital case volumes are associated with improved outcomes for high-risk procedures. The hospital-outcome association for complex but low-mortality procedures and the association between surgeon versus hospital case volume and surgical outcomes have been less explored. The authors examined the association between surgeon and hospital volume and the success for free tissue transfer (free flap) surgery. The authors hypothesized that there would be positive associations between hospital and surgeon volume and the success of free flap surgery. METHODS: The study design was a cross-sectional analysis of adults aged 18 to 64 years who underwent free flap surgery. The authors used 100 percent of all free flap operations between 2001 and 2012 using Taiwan's national data that cover the entire population of 23 million in the country. The authors applied hierarchical regression modeling to analyze volume-outcome associations. RESULTS: The association between hospital volume and free flap success was small but positive (OR, 1.007; 95 percent CI, 1.00 to 1.01). For surgeons, their years of experience had a positive association with success of the operation (OR, 1.04; 95 percent CI, 1.02 to 1.06) rather than their annual case volume. Compared with low-volume surgeons (<11 annual cases) working in low-volume hospitals (<95 annual cases), high-volume surgeons (>25 annual cases) working in high-volume hospitals (>156 annual cases) showed greater odds of operation success (OR, 2.97; 95 percent CI, 1.21 to 7.29). CONCLUSIONS: Higher volume hospitals and more experienced surgeons, regardless of their annual volume, showed better outcomes. Increasing demand for high-quality care and Taiwan's national policies toward centralization of complex surgical procedures have increased competition among hospitals. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
BACKGROUND: Greater hospital case volumes are associated with improved outcomes for high-risk procedures. The hospital-outcome association for complex but low-mortality procedures and the association between surgeon versus hospital case volume and surgical outcomes have been less explored. The authors examined the association between surgeon and hospital volume and the success for free tissue transfer (free flap) surgery. The authors hypothesized that there would be positive associations between hospital and surgeon volume and the success of free flap surgery. METHODS: The study design was a cross-sectional analysis of adults aged 18 to 64 years who underwent free flap surgery. The authors used 100 percent of all free flap operations between 2001 and 2012 using Taiwan's national data that cover the entire population of 23 million in the country. The authors applied hierarchical regression modeling to analyze volume-outcome associations. RESULTS: The association between hospital volume and free flap success was small but positive (OR, 1.007; 95 percent CI, 1.00 to 1.01). For surgeons, their years of experience had a positive association with success of the operation (OR, 1.04; 95 percent CI, 1.02 to 1.06) rather than their annual case volume. Compared with low-volume surgeons (<11 annual cases) working in low-volume hospitals (<95 annual cases), high-volume surgeons (>25 annual cases) working in high-volume hospitals (>156 annual cases) showed greater odds of operation success (OR, 2.97; 95 percent CI, 1.21 to 7.29). CONCLUSIONS: Higher volume hospitals and more experienced surgeons, regardless of their annual volume, showed better outcomes. Increasing demand for high-quality care and Taiwan's national policies toward centralization of complex surgical procedures have increased competition among hospitals. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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