Hospital Teaching Status and Medicare Expenditures for Complex Surgery

Pradarelli, Jason C.; Scally, Christopher P.; Nathan, Hari; Thumma, Jyothi R.; Dimick, Justin B.

doi:10.1097/sla.0000000000001706

Cited by 44 publications

(38 citation statements)

References 38 publications

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“…Mortality is generally found to be lower in patients undergoing surgery at teaching hospitals compared to non-teaching hospitals. [22][23][24][25][26] Surgical complications, however, are higher at teaching hospitals. 23,26 Mechanisms underlying higher morbidity in teaching hospitals are unclear, but longer operative time due to resident involvement is thought to play a role.…”

Section: Discussionmentioning

confidence: 99%

“…[22][23][24][25][26] Surgical complications, however, are higher at teaching hospitals. 23,26 Mechanisms underlying higher morbidity in teaching hospitals are unclear, but longer operative time due to resident involvement is thought to play a role. 27 To date, the relationship between teaching hospitals and postoperative opioid prescribing is not well described, but trainee prescribing may be contributory.…”

Section: Discussionmentioning

confidence: 99%

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A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals

Cron

Hwang

et al. 2019

Surgery

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Background: Postoperative opioid prescribing is often excessive, but the differences in opioid prescribing between teaching hospitals and non-teaching hospitals is not well understood. Given the workload of surgical training and frequent turnover of prescribers on surgical services, we hypothesized that postoperative opioid prescribing would be higher among teaching compared to non-teaching hospitals. Study design: We used insurance claims from a statewide quality collaborative in Michigan to identify 17,075 opioid-naïve patients who underwent 22 surgical procedures across 76 hospitals from 2012-2016. Our outcomes included 1) the amount of opioid prescribed for the initial postoperative prescription in oral morphine equivalents [OME] and 2) high risk prescribing in the 30 days after surgery (high daily dose [≥100 OME], new long-acting/extended-release opioid, overlapping prescriptions, or concurrent benzodiazepine prescription). Teaching hospital status was obtained from the 2014 American Hospital Association survey. Multilevel regression was used to adjust for patient and procedural factors and to perform reliability adjustment. Results: The amount of opioid prescribed per initial opioid prescription varied 4.7-fold across all hospitals from 130 OME to 616 OME. Patients discharged from teaching hospitals filled larger initial opioid prescriptions overall compared with non-teaching hospitals (251 OME vs. 232

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals

Cron

Hwang

et al. 2019

Surgery

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“…Moreover, it may not be practical to develop, maintain, update, and use separate comorbidity scores for each procedure and outcome. Furthermore, our surgery‐specific comorbidity score will be useful when researchers study multiple surgeries together . Future studies with larger datasets can develop procedure‐specific scores and test their performance with our comorbidity score.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our surgery-specific comorbidity score will be useful when researchers study multiple surgeries together. 5,38,39 Future studies with larger datasets can develop procedure-specific scores and test their performance with our comorbidity score.…”

Section: Discussionmentioning

confidence: 99%

Development of comorbidity score for patients undergoing major surgery

Mehta

Shan

Sura

et al. 2019

Health Services Research

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Objective To develop and validate a claims‐based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores. Data Source Five percent Medicare data from 2007 to 2014. Study Design Retrospective cohort study of patients aged ≥65 years undergoing six major operations (N = 99 250). Data Collection One‐year mortality was the primary outcome. Secondary outcomes were hospital mortality, 30‐day mortality, 30‐day readmission, and length of stay. The comorbidity score was developed in the derivation cohort (70 percent sample) using logistic regression model. The comorbidity score was calibrated and validated in the validation cohort (30 percent sample), and compared against the Charlson, Elixhauser, and Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS‐HCC) comorbidity scores using c‐statistic, net reclassification improvement, and integrated discrimination improvement. Principal Findings In the validation cohort, the surgery‐specific comorbidity score was well calibrated and performed better than the Charlson, Elixhauser, and CMS‐HCC comorbidity scores for all outcomes; the performance was comparable to the CMS‐HCC for 30‐day readmission. For example, the surgery‐specific comorbidity score (c‐statistic = 0.792; 95% CI, 0.785‐0.799) had greater discrimination than the Charlson (c‐statistic = 0.747; 95% CI, 0.739‐0.755), Elixhauser (c‐statistic = 0.747; 95% CI, 0.735‐0.755), or CMS‐HCC (c‐statistic = 0.755; 95% CI, 0.747‐0.763) scores in predicting 1‐year mortality. The net reclassification improvement and integrated discrimination improvement were greater for surgery‐specific comorbidity score compared to the Charlson, Elixhauser, and CMS‐HCC scores. Conclusions Compared to commonly used comorbidity measures, a surgery‐specific comorbidity score better predicted outcomes in the surgical population.

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“…22 In large studies of complex general surgery and orthopedic surgery procedures, teaching hospitals consistently had high costs. 23,24 On the other hand, teaching hospitals also see a disproportionate share of vulnerable, economically disadvantaged, high-risk, and complex patients, 25 and truly fair comparisons to nonteaching hospitals are challenging to make. Regardless of the hospital teaching status, the increased costs associated with postoperative hematoma will surely be an area of interest in the coming years as cost becomes a more central factor in healthcare decision making.…”

Section: Discussionmentioning

confidence: 99%

Neck hematoma after major head and neck surgery: Risk factors, costs, and resource utilization

et al. 2018

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Hospital Teaching Status and Medicare Expenditures for Complex Surgery

Abstract: After price-standardization to account for intended differences in Medicare spending, risk-adjusted Medicare payments for an episode of surgical care were similar at teaching hospitals and nonteaching hospitals for three complex inpatient operations.

Cited by 44 publications

References 38 publications

A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals

A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals

Development of comorbidity score for patients undergoing major surgery

Neck hematoma after major head and neck surgery: Risk factors, costs, and resource utilization

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