Is Bigger Always Better? A Nationwide Study of Hip Fracture Unit Volume, 30-Day Mortality, Quality of In-Hospital Care, and Length of Hospital Stay

Kristensen, Pia Kjær; Thillemann, Theis Muncholm; Johnsen, Søren Paaske

doi:10.1097/mlr.0000000000000234

Cited by 45 publications

(54 citation statements)

References 24 publications

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“…10, 19–21 It is also worth noting that while the vast majority of studies have demonstrated a morbidity and mortality benefit to patients undergoing surgery at high volume centers, the literature is not universally supportive of this notion. 21–23 …”

Section: Discussionmentioning

confidence: 99%

Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

et al. 2015

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BACKGROUND Hospital and provider surgical volume have been increasingly linked to surgical outcomes. However, this topic has rarely been addressed in children. Our objective was to investigate whether hospital surgical volume impacts complication rates in pediatric urology. METHODS We retrospectively reviewed the Nationwide Inpatient Sample (1998–2011) for pediatric (≤ 18 years) admissions for urologic procedures. We used ICD-9-CM codes to identify elective urologic interventions and National Surgical Quality Improvement Program (NSQIP) inhospital post-operative complications. Annual hospital surgical volume was calculated and dichotomized as high-volume (>90th percentile) or non-high-volume hospitals (<90th percentile). RESULTS In total, we identified 158,804 urologic admissions (114,634 high-volume hospital admissions and 44,171 non-high-volume hospital admissions). 75% of hospitals performed fewer than 5 major pediatric urology cases per year. High-volume hospitals treated significantly younger patients (mean 5.4 vs 9.6 years, p<0.001), and were more likely to be teaching hospitals (93% vs 71%, p<0.001). The overall rate of NSQIP-identified postoperative complications was higher at non-high-volume hospitals (11.6%) than at high-volume hospitals (9.3%, p=0.003). After adjusting for confounding effects, patients treated at non-high-volume hospitals remained more likely to suffer multiple NSQIP-tracked postoperative complications: acute renal failure (OR 1.4, p=0.04), UTI (OR 1.3, p=0.01), post-op respiratory complications (OR 1.5, p=0.01), systemic sepsis (OR 2.0, p=<0.001), post-op bleeding (OR 2.5, p<0.001), and in-hospital death (OR=2.2, p=0.007). CONCLUSIONS Urologic procedures performed on children at non-high-volume hospitals were associated with an elevated risk of in-hospital, NSQIP-identified postoperative complications, including a small but significant increase in postoperative mortality mostly in nephrectomy and percutaneous nephrolithotomy.

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Section: Discussionmentioning

confidence: 99%

Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

et al. 2015

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“…[17] Hospital surgical volume is often linked to quality of care and access to resources. [6] We dichotomized hospitals into higher and lower volume categories by comparing their annual volumes in the year of index surgery with the median of average annual volumes among hospitals of the same type (174 surgeries for teaching hospitals, 141 for community large hospitals, 37 for community medium hospitals). [18,19] Admission time was previously linked to access to resources with fewer support services from late Friday to Monday morning.…”

Section: Methodsmentioning

confidence: 99%

Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors

Sobolev¹,

Guy²,

Bohm³

et al. 2017

Medicine

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“…Previous studies have shown an association between a higher volume of hip fracture surgeries and delays, complications and death. 40,41 The studies suggest underprioritization of hip fracture over other surgeries at high-volume sites. 40,41 Hospital occupancy has also been associated with risk of in-hospital death after hip fracture.…”

Section: Discussionmentioning

confidence: 99%

“…40,41 The studies suggest underprioritization of hip fracture over other surgeries at high-volume sites. 40,41 Hospital occupancy has also been associated with risk of in-hospital death after hip fracture. 31 Future research should explore the association among teaching status, bed capacity, occupancy and volume to better our understanding of outcomes of hip fracture care delivery.…”

Section: Discussionmentioning

confidence: 99%

In-hospital mortality after hip fracture by treatment setting

Sobolev

Guy

Kuramoto

et al. 2016

CMAJ

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Is Bigger Always Better? A Nationwide Study of Hip Fracture Unit Volume, 30-Day Mortality, Quality of In-Hospital Care, and Length of Hospital Stay

Abstract: Patients admitted to high-volume hip fracture units had higher mortality rates, received a lower quality of in-hospital care, and had longer length of hospital stay.

Cited by 45 publications

References 24 publications

Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States

Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors

In-hospital mortality after hip fracture by treatment setting

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