Impact of hospital volume on resource use after elective cardiac surgery: A contemporary analysis

Hadaya, Joseph; Sanaiha, Yas; Hernández, Roland A.; Tran, Zachary; Shemin, Richard J.; Benharash, Peyman

doi:10.1016/j.surg.2021.03.004

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…Prior studies have found evidence of reduced health care costs at centers with high operative volume in the setting of adult and congenital cardiac surgery and pneumonectomy. 11,14,15 In our cohort of RATS lobectomies, we identified a nonlinear, inverse relationship between robotic volume and costs (Fig. 2).…”

Section: Discussionmentioning

confidence: 93%

“…A vast body of literature has described an inverse relationship between hospital volume and associated mortality or complications across a diverse set of procedures, including congenital cardiac operations, oncologic ablations, and pancreaticoduodenectomy 10–13 . Moreover, high-volume centers accrue lower hospitalization costs following cardiac and thoracic operations, a finding that is most attributable to centralized care pathways, greater institutional experience, and avoidance of costly complications 14,15 . However, such relationships have not been characterized in the context of RATS lobectomy, and whether high surgical volume can mitigate the costs associated with robotic surgery remains unexplored.…”

mentioning

confidence: 99%

“…[10][11][12][13] Moreover, high-volume centers accrue lower hospitalization costs following cardiac and thoracic operations, a finding that is most attributable to centralized care pathways, greater institutional experience, and avoidance of costly complications. 14,15 However, such relationships have not been characterized in the context of RATS lobectomy, and whether high surgical volume can mitigate the costs associated with robotic surgery remains unexplored.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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confidence: 99%

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

et al. 2022

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Section: Methodsmentioning

confidence: 99%

“…Adults undergoing elective CABG and/or valve operations from 2016 to 2019 were identified using previously published International Classification of Diseases, Tenth Revision-10 codes. 20 Patients with missing data for age, sex, inhospital mortality, and costs were excluded (0.6%, 3766 patients). Operations were grouped into isolated CABG, isolated valve repair or replacement, CABG with single valve repair or replacement, and multivalve surgery.…”

Section: Data Source and Derivation Of Study Populationmentioning

confidence: 99%

Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery

et al. 2022

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Objective: To characterize the impact of pulmonary complications (PCs) on mortality, costs, and readmissions after elective cardiac operations in a national cohort and to test for hospital-level variation in PC. Background: PC after cardiac surgery are targets for quality improvement efforts. Contemporary studies evaluating the impact of PC on outcomes are lacking, as is data regarding hospital-level variation in the incidence of PC. Methods: Adults undergoing elective coronary artery bypass grafting and/or valve operations were identified in the 2016-2019 Nationwide Readmissions Database. PC was defined as a composite of reintubation, prolonged (>24 hours) ventilation, tracheostomy, or pneumonia. Generalized linear models were fit to evaluate associations between PC and outcomes. Institutional variation in PC was studied using observed-to-expected ratios. Results: Of 588,480 patients meeting study criteria, 6.7% developed PC. After risk adjustment, PC was associated with increased odds of mortality (14.6, 95% CI, 12.6–14.8), as well as a 7.9-day (95% CI, 7.6–8.2) increase in length of stay and $41,300 (95% CI, 39,600–42,900) in attributable costs. PC was associated with 1.3-fold greater hazard of readmission and greater incident mortality at readmission (6.7% vs 1.9%, P<0.001). Significant hospital-level variation in PC was present, with observed-to-expected ratios ranging from 0.1 to 7.7. Conclusions: Pulmonary complications remain common after cardiac surgery and are associated with substantially increased mortality and expenditures. Significant hospital-level variation in PC exists in the United States, suggesting the need for systematic quality improvement efforts to reduce PC and their impact on outcomes.

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Timing of Coronary Artery Bypass Grafting in Acute Coronary Syndrome: A National Analysis

Hadaya

Sanaiha

Tran

et al. 2022

The Annals of Thoracic Surgery

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Impact of hospital volume on resource use after elective cardiac surgery: A contemporary analysis

Cited by 13 publications

References 23 publications

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

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

Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery

Timing of Coronary Artery Bypass Grafting in Acute Coronary Syndrome: A National Analysis

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