Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson's disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortality, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients was discharged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (86.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR &gt; 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148–1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202–8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781–7.048], p &lt; 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p &lt; 0.001), private hospitals (OR 11.027, p &lt; 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p = 0.033] and OR 2.897 [p = 0.031], respectively) were independent predictors of higher hospital cost. The mean length of hospital stay decreased from 2.03 days in 2006 to 1.55 days in 2010. There was no difference in the discharge disposition among academic versus nonacademic centers and rural versus urban hospitals (p &gt; 0.05).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Elderly female patients with nonprivate insurance and high comorbidity index who underwent surgery at low-volume centers performed by a surgeon with a low annual case volume and the occurrence of postoperative complications were correlated with an adverse discharge disposition. High-volume, government-owned academic centers in the Northeast were associated with a lower cost incurred to the hospitals. It can be recommended that the widespread availability of this procedure across small, academic centers in rural areas may not only provide easier access to the patients but also reduces the total cost of hospitalization.</jats:p></jats:sec>

An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases

“…Prior studies using the Nationwide Inpatient Sample found a beneficial association between surgical volume and outcome [14,26], so it is possible that by including many low-volume surgical centers in the above analysis, we observe an increased rate of revisions and removals that high-volume centers do not encounter—and these are the centers that typically publish their surgical experiences. Such volume-outcome relationships have been observed in nearly all areas of neurosurgery [27], and could be explored as a possible contributor to DBS revisions.…”

“…Medical and surgical complications are strictly defined, unlike many retrospective studies, and the data entry personnel are frequently audited to ensure accurate additions to the database. Unlike the commonly studied Nationwide Inpatient Sample (NIS) [14,18], NSQIP does not rely on billing statistics for its data acquisition, and is based on the more specific Current Procedure Terminology (CPT) codes to identify surgical procedures, rather than the International Classification of Diseases (ICD-9) codes. As an example, ICD-9 has one code for primary placement or revision of DBS leads (02.93), but there is no way to determine whether a procedure is a primary placement or revision from ICD-9.…”

Effects of a Surgical Receipt Program on the Supply Costs of Five General Surgery Procedures

“…This equates to approximately $160 billion annually 2 . Previous literature has demonstrated that disposable surgical supplies, both implantable and non-implantable, represent a significant portion of surgery-associated costs 3,4 . Although surgeons are often not involved in the negotiation of supply costs with suppliers, they play an integral role in providing feedback to administrators on which surgical supplies should be purchased for the OR and have direct control on which specific disposable supply to use in a given case.…”

The changing landscape of vestibular schwannoma diagnosis and management: A cross‐sectional study

“…This implies that, although more people are likely to live close to a private institution, most of our cohort sought treatment at an academic center. Studies suggest that many baseline confounders may be present, including age, socioeconomic status, ethnicity, baseline morbidity, or hospital caseloads, rendering simple comparison challenging . Regardless, we demonstrated that this study's patients receiving care at academic and nonacademic private institutions had similar eventual treatment distribution and satisfaction with this decision.…”