Hospital variation in the development of respiratory failure after pulmonary lobectomy: A national analysis

Verma, Arjun; Tran, Zachary; Hadaya, Joseph; Lee, Cory; Madrigal, Josef; Revels, Sha’Shonda L.; Benharash, Peyman

doi:10.1016/j.surg.2022.03.022

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…Given the high-risk and resource-intensive nature of esophagectomy, we sought to characterize clinical and financial outcomes at safety-net hospitals using the largest readmissions database in the United States. Most commonly large, metropolitan teaching institutions, SNH were found to serve a majority lower-income population, as previously reported [22][23][24][25][26][27][28][29][30][31][32]. We identified a significant increase in the annual proportion of procedures performed at SNH.…”

Section: Discussionsupporting

confidence: 59%

“…First, we limited the cohort to those with gastroesophageal malignancy, excluding patients with benign disease. Second, we constructed a two-level (patient and hospital, respectively), mixed-effects model to assess outcomes of interest, with the random effect being the NRD hospital identifier [ 27 , 28 ]. Thirdly, we utilized entropy balancing to balance groups across patient, operative, and hospital factors, to isolate the relationship between SNH status and outcomes of interest.…”

Section: Methodsmentioning

confidence: 99%

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Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

Sakowitz,

Mabeza,

Bakhtiyar

et al. 2023

PLoS ONE

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Background While safety-net hospitals (SNH) play a critical role in the care of underserved communities, they have been associated with inferior postoperative outcomes. This study evaluated the association of hospital safety-net status with clinical and financial outcomes following esophagectomy. Methods All adults (≥18 years) undergoing elective esophagectomy for benign and malignant gastroesophageal disease were identified in the 2010–2019 Nationwide Readmissions Database. Centers in the highest quartile for the proportion of uninsured/Medicaid patients were classified as SNH (others: non-SNH). Regression models were developed to evaluate adjusted associations between SNH status and outcomes, including in-hospital mortality, perioperative complications, and resource use. Royston-Parmar flexible parametric models were used to assess time-varying hazard of non-elective readmission over 90 days. Results Of an estimated 51,649 esophagectomy hospitalizations, 9,024 (17.4%) were performed at SNH. While SNH patients less frequently suffered from gastroesophageal malignancies (73.2 vs 79.6%, p<0.001) compared to non-SNH, the distribution of age and comorbidities were similar. SNH was independently associated with mortality (AOR 1.24, 95% CI 1.03–1.50), intraoperative complications (AOR 1.45, 95% CI 1.20–1.74) and need for blood transfusions (AOR 1.61, 95% CI 1.35–1.93). Management at SNH was also associated with incremental increases in LOS (+1.37, 95% CI 0.64–2.10), costs (+10,400, 95% CI 6,900–14,000), and odds of 90-day non-elective readmission (AOR 1.11, 95% CI 1.00–1.23). Conclusions Care at safety-net hospitals was associated with higher odds of in-hospital mortality, perioperative complications, and non-elective rehospitalization following elective esophagectomy. Efforts to provide sufficient resources at SNH may serve to reduce complications and overall costs for this procedure.

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Section: Discussionsupporting

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

Sakowitz,

Mabeza,

Bakhtiyar

et al. 2023

PLoS ONE

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“…22 Nonetheless, given the costly nature of adverse events after pulmonary lobectomy, our findings support the hypothesis that the reduction in costly complications at HVH is partly responsible for lower expenditure at these centers. 23,24 Efforts to disseminate best practices that may reduce complications, including rigorous prehabilitation, preoperative nutritional optimization, and stringent patient selection criteria, align with goals of value-based health care delivery.…”

Section: Discussionmentioning

confidence: 99%

The Presence of a Cost–Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections

et al. 2022

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Objective: To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs. Background: The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking. Methods: Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions. Results: An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P<0.001), as well as significantly reduced length of stay (−0.8 d, P<0.001) and costs (−$3900, P<0.001). Conclusions: Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.

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“…The intraclass correlation coefficient (ICC) was calculated to determine the degree of variation in post‐transplantation LOS that was attributable to interhospital differences. The absolute values of random effects were calculated as the Best Linear Unbiased Prediction, using the previously described methodology 14 . These values were considered to be the change in post‐transplantation LOS (in days) attributable to care at each center.…”

Section: Methodsmentioning

confidence: 99%

“…The absolute values of random effects were calculated as the Best Linear Unbiased Prediction, using the previously described methodology. 14 These values were considered to be the change in post-transplantation LOS (in days)…”

Section: Study Population and Outcomesmentioning

confidence: 99%

Postoperative length of stay following kidney transplantation in patients without delayed graft function—An analysis of center‐level variation and patient outcomes

Bakhtiyar

Benharash

Verma

et al. 2023

Clinical Transplantation

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Background: Early discharge after surgical procedures has been proposed as a novel strategy to reduce healthcare expenditures. However, national analyses of the association between discharge timing and post-transplant outcomes following kidney transplantation are lacking. Methods: This was a retrospective cohort study of all adult kidney transplant recipients without delayed graft function from 2014 to 2019 in the Organ Procurement and Transplantation Network and Nationwide Readmissions Databases. Recipients were divided into Early (LOS ≤ 4 days), Routine (LOS 5-7), and Delayed (LOS > 7) cohorts. Results: Of 61 798 kidney transplant recipients, 26 821 (43%) were discharged Early and 23 279 (38%) Routine. Compared to Routine, patients discharged Early were younger (52 [41-61] vs. 54 [43-62] years, p < .001), less commonly Black (33% vs. 34%, p < .001), and more frequently had private insurance (41% vs. 35%, p < .001). After adjustment, Early discharge was not associated with inferior 1-year patient survival (Hazard Ratio [HR] .74, 95% Confidence Interval [CI] 0.66-0.84) or increased likelihood of nonelective readmission at 90-days (HR .93, CI .89-.97), relative to Routine discharge. Discharging all Routine patients as Early would result in an estimated cost saving of ∼$40 million per year. Multi-level modeling of post-transplantationLOS revealed that 28.8% of the variation in LOS was attributable to interhospital differences rather than patient factors.

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Hospital variation in the development of respiratory failure after pulmonary lobectomy: A national analysis

Cited by 9 publications

References 21 publications

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

The Presence of a Cost–Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections

Postoperative length of stay following kidney transplantation in patients without delayed graft function—An analysis of center‐level variation and patient outcomes

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