Ronnie L Shammas1, Yi Ren1, Samantha M Thomas1, Brett T Phillips1, Scott T Hollenbeck1, Rachel A Greenup1. 1. From the Division of Plastic, Maxillofacial, and Oral Surgery and the Department of Surgery, Duke University Medical Center; the Biostatistics Shared Resource, Duke Cancer Institute; the Department of Biostatistics and Bioinformatics, Duke University; and the Duke Cancer Institute.
Abstract
BACKGROUND: Hospital volume has been correlated with improved outcomes in oncologic care and complex surgical procedures. The authors sought to determine the relationship between overall annual hospital volume and perioperative outcomes following free flap breast reconstruction. METHODS: Free flap breast reconstruction patients (n = 7991) were identified at 1907 centers using the Healthcare Cost and Utilization Project National Inpatient Sample database. Logistic regression characterized the association of hospital volume (total discharges per year) with systemic, surgical, and microsurgical complications. Patients were categorized as being treated at low- versus high-volume hospitals based on identified threshold volumes, and the association with the incidence of complications was estimated. RESULTS: Initially, restricted cubic spline analysis suggested potential threshold volumes of 13,018 (95 percent CI, 7468 to 14,512) and 7091 (95 percent CI, 5396 to 9918) discharges per year, at which the risk for developing systemic and microsurgical complications may change, respectively. However, further patient-level evaluation of treatment at low- versus high-volume hospitals demonstrated that hospital volume did not predict the risk of developing perioperative systemic (OR, 1.28; 95 percent CI, 0.75 to 2.18; p = 0.36) or microsurgical complications (OR, 1.06; 95 percent CI, 0.78 to 1.44; p = 0.73). CONCLUSIONS: Perioperative complications after free flap breast reconstruction did not differ between patients treated at low- versus high-volume hospitals after in-depth multiprong analysis. Patient outcomes are more likely associated with surgeon and programmatic experience. Overall annual hospital volume should not serve as a proxy for high-quality breast free flap care. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
BACKGROUND: Hospital volume has been correlated with improved outcomes in oncologic care and complex surgical procedures. The authors sought to determine the relationship between overall annual hospital volume and perioperative outcomes following free flap breast reconstruction. METHODS: Free flap breast reconstruction patients (n = 7991) were identified at 1907 centers using the Healthcare Cost and Utilization Project National Inpatient Sample database. Logistic regression characterized the association of hospital volume (total discharges per year) with systemic, surgical, and microsurgical complications. Patients were categorized as being treated at low- versus high-volume hospitals based on identified threshold volumes, and the association with the incidence of complications was estimated. RESULTS: Initially, restricted cubic spline analysis suggested potential threshold volumes of 13,018 (95 percent CI, 7468 to 14,512) and 7091 (95 percent CI, 5396 to 9918) discharges per year, at which the risk for developing systemic and microsurgical complications may change, respectively. However, further patient-level evaluation of treatment at low- versus high-volume hospitals demonstrated that hospital volume did not predict the risk of developing perioperative systemic (OR, 1.28; 95 percent CI, 0.75 to 2.18; p = 0.36) or microsurgical complications (OR, 1.06; 95 percent CI, 0.78 to 1.44; p = 0.73). CONCLUSIONS: Perioperative complications after free flap breast reconstruction did not differ between patients treated at low- versus high-volume hospitals after in-depth multiprong analysis. Patient outcomes are more likely associated with surgeon and programmatic experience. Overall annual hospital volume should not serve as a proxy for high-quality breast free flap care. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Authors: Amanda R Sergesketter; Samantha M Thomas; Whitney O Lane; Jonah P Orr; Ronnie L Shammas; Oluwadamilola M Fayanju; Rachel A Greenup; Scott T Hollenbeck Journal: Plast Reconstr Surg Date: 2019-06 Impact factor: 4.730
Authors: Parisa Kamali; Marek A Paul; Ahmed M S Ibrahim; Pieter G L Koolen; Winona Wu; Marc L Schermerhorn; Bernard T Lee; Samuel J Lin Journal: Ann Plast Surg Date: 2017-06 Impact factor: 1.539
Authors: Mohamed Abdelgadir Adam; Samantha Thomas; Linda Youngwirth; Terry Hyslop; Shelby D Reed; Randall P Scheri; Sanziana A Roman; Julie A Sosa Journal: Ann Surg Date: 2017-02 Impact factor: 12.969
Authors: Melissa M Sarver; Jess D Rames; Yi Ren; Rachel A Greenup; Ronnie L Shammas; E Shelley Hwang; Scott T Hollenbeck; Terry Hyslop; Paris D Butler; Oluwadamilola M Fayanju Journal: J Am Coll Surg Date: 2022-05-01 Impact factor: 6.532