Courtney J Balentine1, Meredith C Mason2, Peter J Richardson3, Panagiotis Kougias4, Faisal Bakaeen5, Aanand D Naik6, David H Berger4, Daniel A Anaya7. 1. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: cbalentine@uabmc.edu. 2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. 3. Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (IQUEST), Houston, Texas. 4. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (IQUEST), Houston, Texas. 5. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 6. Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (IQUEST), Houston, Texas; Alkek Department of Medicine, Baylor College of Medicine, Houston, Texas. 7. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
Abstract
BACKGROUND: Variation in use of postacute care (PAC), including skilled nursing facilities and inpatient rehabilitation, accounts for 73% of regional variation in Medicare spending. Studies of hospital variation in PAC use have typically focused on nonsurgical patients or have been limited to Medicare data. Consequently, there is no nationally representative data on how rates of postoperative discharge to PAC differ between hospitals. The purpose of this study was to explore hospital-level variation in PAC utilization after cardiovascular and abdominal surgery. MATERIALS AND METHODS: We evaluated 3,487,365 patients from the Nationwide Inpatient Sample and 60,666 from the Veterans Affairs health system, who had colorectal surgery, hepatectomy, pancreatectomy, coronary bypass, aortic aneurysm repair, and peripheral vascular bypass from 2008 to 2011. For each hospital, we calculated unadjusted and risk-adjusted observed-to-expected ratios for discharge to PAC facilities (skilled nursing or inpatient rehabilitation). RESULTS: A total of 631,199 (18%) non-veterans and 4744 (8%) veterans were discharged to PAC facilities. For veterans, 32% were ≥70 y old, and 98% were men. For non-veterans, 39% were ≥70, and 60% were men. Hospital rates of discharge to PAC facilities varied from 1% to 36% for veterans hospitals and from 1% to 59% for non-veteran hospitals. Risk-adjusted observed-to-expected ratios ranged from 0.10 to 4.15 for veterans and from 0.11 to 4.3 for non-veteran hospitals. CONCLUSIONS: There is substantial variation in PAC utilization and rates of home discharge after abdominal and cardiovascular surgery. To reduce variation, further research is needed to understand health systems factors that influence PAC utilization. Published by Elsevier Inc.
BACKGROUND: Variation in use of postacute care (PAC), including skilled nursing facilities and inpatient rehabilitation, accounts for 73% of regional variation in Medicare spending. Studies of hospital variation in PAC use have typically focused on nonsurgical patients or have been limited to Medicare data. Consequently, there is no nationally representative data on how rates of postoperative discharge to PAC differ between hospitals. The purpose of this study was to explore hospital-level variation in PAC utilization after cardiovascular and abdominal surgery. MATERIALS AND METHODS: We evaluated 3,487,365 patients from the Nationwide Inpatient Sample and 60,666 from the Veterans Affairs health system, who had colorectal surgery, hepatectomy, pancreatectomy, coronary bypass, aortic aneurysm repair, and peripheral vascular bypass from 2008 to 2011. For each hospital, we calculated unadjusted and risk-adjusted observed-to-expected ratios for discharge to PAC facilities (skilled nursing or inpatient rehabilitation). RESULTS: A total of 631,199 (18%) non-veterans and 4744 (8%) veterans were discharged to PAC facilities. For veterans, 32% were ≥70 y old, and 98% were men. For non-veterans, 39% were ≥70, and 60% were men. Hospital rates of discharge to PAC facilities varied from 1% to 36% for veterans hospitals and from 1% to 59% for non-veteran hospitals. Risk-adjusted observed-to-expected ratios ranged from 0.10 to 4.15 for veterans and from 0.11 to 4.3 for non-veteran hospitals. CONCLUSIONS: There is substantial variation in PAC utilization and rates of home discharge after abdominal and cardiovascular surgery. To reduce variation, further research is needed to understand health systems factors that influence PAC utilization. Published by Elsevier Inc.
Authors: Alisha Lussiez; John R Montgomery; Naveen F Sangji; Zhaohui Fan; Bryant W Oliphant; Mark R Hemmila; Justin B Dimick; John W Scott Journal: J Trauma Acute Care Surg Date: 2021-08-01 Impact factor: 3.697
Authors: Claire L Griffin; Vikas Sharma; Mark R Sarfati; Brigitte K Smith; Larry W Kraiss; Stephen H McKellar; Antigone Koliopoulou; Benjamin S Brooke; Craig H Selzman; Jason P Glotzbach Journal: J Vasc Surg Date: 2020-04-30 Impact factor: 4.268