Hospital Procedure Volume May Not Capture Facility Quality
Major Finding: Hospital procedure volume is not significantly associated with in-hospital mortality for four common surgical procedures.
Data Source: The researchers used data from the NIS in 2008. They obtained weighted-discharge records for 19,194 patients who had pancreatic resection, 15,266 who had AAA repair, 4,764 who had esophageal resection, and 222,122 who had CABG. The primary outcome of interest was the estimated risk-adjusted effect of hospital procedure volume on mortality (in-hospital death).
Disclosures: The authors reported that they have no financial disclosures.
FROM THE ANNUAL MEETING OF THE AMERICAN SURGICAL ASSOCIATION
If the causative factors could be identified, "then we could take the experience of high-volume centers and translate that to everybody else, so everybody could have good outcomes," he said.
According to Dr. Livingston, the Dr. Lee Hudson–Robert R. Penn Chair in Surgery at the University of Texas, Dallas, previous studies relied on statistical modeling of the mortality relationship. "Those models are only as good as the model can represent the data," he said, and very few have been rigorously assessed to see how well they describe the phenomenon that they’re trying to describe.
Dr. LaPar’s rigorous work shows that the models don’t actually work that well, said Dr. Livingstone. This paper "should serve as the template for what everyone should do when they’re performing volume outcome studies or any kind of regression analysis."
Dr. Livingston asked what metric should be used in place of volume. Dr. LaPar replied, "I think that’s the billion dollar question. ... This is a complex issue; this is a multifactorial issue that likely includes many different qualitative and quantitative measures that we’re going to have to take a look at."
The authors reported that they have no financial disclosures.
The complete manuscript of the presentation is anticipated to be published in the Annals of Surgery pending editorial review.
