Maria S Altieri1, Jie Yang2, Donald Groves3, Donglei Yin4, Kristen Cagino3, Mark Talamini3, Aurora Pryor3. 1. Division of Bariatric, Department of Surgery, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA. maria.altieri@stonybrookmedicine.edu. 2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA. 3. Division of Bariatric, Department of Surgery, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA. 4. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
Abstract
INTRODUCTION: There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery. METHODS: The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models. RESULTS: There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility. CONCLUSION: No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.
INTRODUCTION: There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery. METHODS: The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models. RESULTS: There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility. CONCLUSION: No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: N Tjarda van Heek; Koert F D Kuhlmann; Rob J Scholten; Steve M M de Castro; Olivier R C Busch; Thomas M van Gulik; Huug Obertop; Dirk J Gouma Journal: Ann Surg Date: 2005-12 Impact factor: 12.969
Authors: M J A M Bakens; Y R B M van Gestel; M Bongers; M G H Besselink; C H C Dejong; I Q Molenaar; O R C Busch; V E P P Lemmens; I H J T de Hingh Journal: Br J Surg Date: 2015-10-05 Impact factor: 6.939
Authors: Zachary J Kastenberg; John M Morton; Brendan C Visser; Jeffrey A Norton; George A Poultsides Journal: HPB (Oxford) Date: 2012-09-24 Impact factor: 3.647
Authors: Jennifer F Tseng; Peter W T Pisters; Jeffrey E Lee; Huamin Wang; Henry F Gomez; Charlotte C Sun; Douglas B Evans Journal: Surgery Date: 2007-01-22 Impact factor: 3.982
Authors: Robert W Eppsteiner; Nicholas G Csikesz; James T McPhee; Jennifer F Tseng; Shimul A Shah Journal: Ann Surg Date: 2009-04 Impact factor: 12.969