Diagnostic Testing for Gastrointestinal Surgery Patients at Academic and Non-Academic Health Systems

Abstract

Introduction/Objective Comparisons of surgical inpatient clinical laboratory test and radiology imaging utilization between multiple academic and non-academic health systems are very uncommon. Methods/Case Report Using the Vizient Clinical Data Base®, with permission from Vizient, Inc. (All rights reserved.), we compared clinical laboratory and imaging utilization over 3 years (2019-2021) for adult patients hospitalized for major GI surgical procedures at mid-size (250-450 hospital beds) academic (N=12; 8,706 hospitalizations) and non- academic (N=18; 7,930 hospitalizations) hospitals across the US. We used Medicare Severity Diagnosis Related Groups (MSDRG), employed by the US Centers for Medicare and Medicaid Services (CMS), to identify hospitalizations for major small and large bowel procedures (MSDRG triplet 329-331). Using single MSDRGs, we stratified patients by comorbid conditions and complications into high, moderate, and low severity groups. We compared the mean number of laboratory tests (CPT codes 80000-89999), and imaging studies (CPT codes 70000- 79999) per hospitalization and per hospital day. We measured aggregate Clinical Resource Intensity Weight (RIW) per hospitalization to quantify diagnostic resource consumption for each encounter. The RIW is based on the CMS Ambulatory Payment Classification weights. Results (if a Case Study enter NA) Academic hospitals had significantly (p<.01) higher mean laboratory tests per encounter (65.6 vs. 43.0 tests, 52.6% higher) and per hospital day (7.6 vs. 5.1 tests, 49.0% higher). Laboratory RIW was also higher at academic hospitals per hospitalization (12.8 vs. 10.3, 24.3% higher) and per hospital day (1.7 vs. 1.5, 13.3% higher). Mean imaging studies were also higher at academic centers per case (3.5 vs. 3.1 studies, 12.9% higher) and per day (0.37 vs. 0.33, 12.1% higher), but lacked statistical significance. Imaging RIW was not significantly different between academic and non-academic hospitals either by encounter (6.5 vs.6.2, 4.8% higher) or per day (0.697 vs. 0.700, 0.4% lower). Analysis of utilization after stratification by severity revealed similar patterns with larger differences at higher severity levels. Conclusion Mean diagnostic tests per hospitalization are greater at academic hospitals. These differences persist after adjustment for hospital length of stay and severity level. Laboratory test RIW is higher at academic hospitals. However, differences are not significant for imaging RIW.