Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study

Crouse, Dan L.; Leonard, Philip S.J.; Boudreau, Jonathan; McDonald, James Ted

doi:10.1503/cjs.006917

Cited by 3 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three studies [21, 33, 62] totaling 140,656 hip arthroplasties were pooled to compare the mortality rates within 30 days postoperatively between LVH and HVH. Based on the results of the random meta-analysis model, we found a significantly higher mortality rate in LVH, RR = 2.33 (CI [1.27, 4.28] I 2 = 93%, p value = 0.006) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…It has been shown that hospitals performing more treatments of a given type exhibit better outcomes than hospitals performing fewer. This is called the “volume-outcome” relationship and several studies have observed this effect in total hip arthroplasty, where the outcomes of hip arthroplasty in hospitals which perform a higher number of hip arthroplasty procedures annually are better than hospitals which perform a fewer number [21–23]. As the current healthcare system endeavors to implement value, centralization of common yet costly surgeries, such as THAs, to high-volume centers of excellence may be an effective way to control the economic burden.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

BackgroundA shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The “volume-outcome” relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA.Materials and methodsWe conducted a review of PubMed (MEDLINE), OVID MEDLINE, Google Scholar, and Cochrane library of studies reporting the impact of hospital volume on THA. The studies were evaluated as per the inclusion and exclusion criteria. A total of 44 studies were included in the review. We accessed pooled data using random-effect meta-analysis.ResultsResults of the meta-analyses show that low-volume hospitals were associated with a higher rate of surgical site infections (1.25 [1.01, 1.55]), longer length of stay (RR, 0.83[0.48–1.18]), increased cost of surgery (3.44, [2.57, 4.30]), 90-day complications (RR, 1.80[1.50–2.17]) and 30-day (RR, 2.33[1.27–4.28]), 90-day (RR, 1.26[1.05–1.51]), and 1-year mortality rates (RR, 2.26[1.32–3.88]) when compared to high-volume hospitals following THA. Except for two prospective studies, all were retrospective observational studies.ConclusionsThese findings demonstrate superior outcomes following THA in high-volume hospitals. Together with the reduced cost of the surgical procedure, fewer complications may contribute to saving considerable opportunity costs annually. However, a need to define objective volume-thresholds with stronger evidence would be required.Trial registrationPROSPERO CRD42019123776.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…This approach allowed us to control for temporal changes in provider volume over the study period and has been applied elsewhere. 23 We also compiled information on each provider's primary specialization, sex and years since completing his or her basic medical training.…”

Section: Provider and Hospital Characteristicsmentioning

confidence: 99%

Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study

Crouse¹,

Boudreau²,

Leonard³

et al. 2020

cjs

Self Cite

View full text Add to dashboard Cite

Background: American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. Methods: We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. Results: Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. Conclusion: Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures. Contexte : Des études américaines ont montré que le volume d'activité des chirurgiens et des hôpitaux est inversement proportionnel au risque de mortalité après la chirurgie colorectale. Les données pour le Canada sont limitées, et à notre connaissance, une seule étude a porté sur d'autres paramètres que le décès. Nous avons décrit les liens entre volume d'activité des chirurgiens et mortalité de toute cause/ complications postopératoires après la chirurgie colorectale au Nouveau-Brunswick. Méthodes : Nous avons utilisé les registres de congés des hôpitaux reliés aux données de la Statistique de l'état civil, du registre provincial du cancer et du registre des patients. Nous avons recensé toutes les admissions pour chirurgie colorectale de 2007 à 2013. Nous avons utilisé la régression logistique pour établir le risque de décès et le risque de complications (fuite anastomotique, colostomie non planifiée, infection intra-abdominale ou pneumonie) dans les 30 jours suivant le congé de l'hôpital par rapport au volume d'activité des chirurgiens (c.-à-d., interventions totales des 2 années précédentes) ajusté en fonction des caractéristiques individuelles et contextuelles, propres aux chir...

show abstract

Fallvolumen und Ergebnis („Volume-Outcome-Beziehung“)

Grundmann

Thomsen

2020

Versorgungsqualität in Der Operativen Medizin

View full text Add to dashboard Cite

Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study

Abstract: Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.

Cited by 3 publications

References 13 publications

Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study

Fallvolumen und Ergebnis („Volume-Outcome-Beziehung“)

Contact Info

Product

Resources

About