Impact of Facility Volume on Patient Safety Indicator Events After Transsphenoidal Pituitary Surgery

Abstract

Objectives To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). Study Design Retrospective database review. Setting National Inpatient Sample database (2003-2011). Methods The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. Results An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P < .001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P < .001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P < .001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P < .001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P < .001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P < .001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P < .001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P < .001). Conclusion PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.

Facility Volume and Pituitary Surgery

“…1 Consistent with our results, we agree with their findings further supporting our conclusion that patients treated at HVFs experienced superior outcomes following endoscopic TSPS. 1 As noted in Chalif's and Aghi's letter, better operative skills and perioperative care developed at HVFs are particularly significant in affecting outcomes for certain patient subgroups such as the elderly. 2 The use of patient safety indicator events (PSIs) draws attention to complications related to operative and perioperative care and our results indicated that PSIs were significantly lower in HVFs compared to non-HVFs.…”

“…According to their letter, results from the National Cancer Database (NCDB) showed that adults undergoing endoscopic TSPS experienced decreased mortality and length of stay at high-volume facilities (HVFs) compared to non-HVFs. 1 Consistent with our results, we agree with their findings further supporting our conclusion that patients treated at HVFs experienced superior outcomes following endoscopic TSPS. 1 As noted in Chalif's and Aghi's letter, better operative skills and perioperative care developed at HVFs are particularly significant in affecting outcomes for certain patient subgroups such as the elderly.…”

“…We read with interest the recent study by Lemdani et al 1 examining the impact of facility volume on patient safety indicator (PSI) events after transsphenoidal pituitary surgery (TSPS). Using the National Inpatient Sample (NIS), they demonstrated that high‐volume facilities (HVFs, representing the 66th percentile of treating facility by terms of total surgical volume) had lower rates of PSI events, as well as lower rates of mortality and other poor outcomes after a PSI event, in comparison to non‐HVFs.…”

“…To directly compare the NCDB to the NIS, we have reanalyzed the NCDB to determine the effect of endoscopic TSPS on morbidity and mortality using inclusion/exclusion criteria similar to Lemdani et al 1 (Table 1). We demonstrate that for all adults undergoing endoscopic TSPS for pituitary adenoma, there is decreased mortality and decreased total length of stay at HVFs compared to non‐HVFs.…”

Response to “Facility Volume and Pituitary Surgery”

“…1 As noted in Chalif's and Aghi's letter, better operative skills and perioperative care developed at HVFs are particularly significant in affecting outcomes for certain patient subgroups such as the elderly. 2 The use of patient safety indicator events (PSIs) draws attention to complications related to operative and perioperative care and our results indicated that PSIs were significantly lower in HVFs compared to non-HVFs. HVFs, as demonstrated in the NCDB and National Inpatient Sample, provide superior care for endoscopic TSPS patients.…”