David Yi1, John R T Monson2, Cathy C Stankiewicz3, Sam Atallah2, Neil J Finkler4. 1. Department of Nursing, Florida Hospital, 601 E. Rollins Street, Orlando, FL, 32803, USA. david.yi@flhosp.org. 2. Center for Colon & Rectal Surgery, Florida Hospital Medical Group, 2501 North Orange Avenue, Suite 240, Orlando, FL, 32803, USA. 3. Department of Nursing, Florida Hospital, 601 E. Rollins Street, Orlando, FL, 32803, USA. 4. Executive Office, Florida Hospital, 601 E. Rollins Street, Orlando, FL, 32803, USA.
Abstract
PURPOSE: To evaluate the impact of surgeon case volumes on procedural, financial, and clinical outcomes in colorectal surgery and apply findings to improve hospital care quality. METHODS: A retrospective review was performed using 2013-2014 administrative data from a large hospital system in Southeast U.S. region; univariate and multivariable regression analyses were used to explore the impact of surgeon case volume on outcomes. RESULTS: One thousand one hundred ninety patients were included in this 2-year study. When compared with low-volume surgeons (LVS) (< 14 cases in 2 years), the high-volume surgeons (HVS) (> 34 cases) were estimated per case to have shorter cut-to-close time in the operation room by 79 min, ([95% CI 58 to 99]), lower total hospitalization cost by $4314, ([95% CI $2261 to $6367]), and shorter post-surgery and overall length of stay by 0.92 days, ([95% CI 0.50 to 1.35]) and 1.27 days ([95% CI 0.56 to 1.98]), respectively. The HVS also showed a higher tendency to choose a laparoscopic approach over an open approach, with an odds ratio of 3.16 ([95% CI 1.23 to 8.07]). When compared with medium-volume surgeons (MVS) (14-34 cases), the HVS were estimated per case to have shorter cut-to-close time in the operation room by 62 min ([95% CI 37 to 87]). Surgeon case volumes had no statistically significant impact on outcomes including in-hospital mortality, 30-day readmission, blood utilization, and surgical site infection (SSI). CONCLUSIONS: Surgeon case volume had positive impacts on procedural, financial, and clinical outcomes and this finding may be used to improve hospital's quality of care.
PURPOSE: To evaluate the impact of surgeon case volumes on procedural, financial, and clinical outcomes in colorectal surgery and apply findings to improve hospital care quality. METHODS: A retrospective review was performed using 2013-2014 administrative data from a large hospital system in Southeast U.S. region; univariate and multivariable regression analyses were used to explore the impact of surgeon case volume on outcomes. RESULTS: One thousand one hundred ninety patients were included in this 2-year study. When compared with low-volume surgeons (LVS) (< 14 cases in 2 years), the high-volume surgeons (HVS) (> 34 cases) were estimated per case to have shorter cut-to-close time in the operation room by 79 min, ([95% CI 58 to 99]), lower total hospitalization cost by $4314, ([95% CI $2261 to $6367]), and shorter post-surgery and overall length of stay by 0.92 days, ([95% CI 0.50 to 1.35]) and 1.27 days ([95% CI 0.56 to 1.98]), respectively. The HVS also showed a higher tendency to choose a laparoscopic approach over an open approach, with an odds ratio of 3.16 ([95% CI 1.23 to 8.07]). When compared with medium-volume surgeons (MVS) (14-34 cases), the HVS were estimated per case to have shorter cut-to-close time in the operation room by 62 min ([95% CI 37 to 87]). Surgeon case volumes had no statistically significant impact on outcomes including in-hospital mortality, 30-day readmission, blood utilization, and surgical site infection (SSI). CONCLUSIONS: Surgeon case volume had positive impacts on procedural, financial, and clinical outcomes and this finding may be used to improve hospital's quality of care.
Entities:
Keywords:
Case volume; Colorectal surgery; Outcomes; Quality improvement
Authors: Rachelle N Damle; Christopher W Macomber; Julie M Flahive; Jennifer S Davids; W Brian Sweeney; Paul R Sturrock; Justin A Maykel; Heena P Santry; Karim Alavi Journal: J Am Coll Surg Date: 2014-03-12 Impact factor: 6.113
Authors: Deborah Schrag; Katherine S Panageas; Elyn Riedel; Laura D Cramer; Jose G Guillem; Peter B Bach; Colin B Begg Journal: Ann Surg Date: 2002-11 Impact factor: 12.969
Authors: David A Etzioni; Tonia M Young-Fadok; Robert R Cima; Nabil Wasif; Robert D Madoff; James M Naessens; Elizabeth B Habermann Journal: Cancer Date: 2014-05-06 Impact factor: 6.860
Authors: Lee Adler; David Yi; Michael Li; Barry McBroom; Loran Hauck; Christine Sammer; Cason Jones; Terry Shaw; David Classen Journal: J Patient Saf Date: 2018-06 Impact factor: 2.844
Authors: Michał Nowakowski; Piotr Małczak; Magdalena Mizera; Mateusz Rubinkiewicz; Anna Lasek; Mateusz Wierdak; Piotr Major; Andrzej Budzyński; Michał Pędziwiatr Journal: J Clin Med Date: 2018-10-27 Impact factor: 4.241