TY - JOUR
T1 - Assessing the Costs Associated with Volume-Based Referral for Hepatic Surgery
AU - Gani, Faiz
AU - Pawlik, Timothy M.
PY - 2016/1/14
Y1 - 2016/1/14
N2 - Background: Although proposed as a means for quality improvement, little is known regarding the economic consequences of volume-based referral. The objective of the current study was to investigate the relationship between inpatient costs and hospital volume. Methods: Patients undergoing elective liver surgery were identified using the Nationwide Inpatient Sample from 2001 to 2012. Multivariable hierarchical regression analyses were performed to calculate and compare risk-adjusted costs and postoperative outcomes across hospital volume terciles. Results: A total of 27,813 patients underwent surgery at 2207 hospitals. Although costs were comparable across the three volume groups (all p > 0.05), patients who developed a postoperative complication incurred a higher overall cost (complication vs. no complication; median costs $17,974 [IQR 13,865–25,623] vs. $41,731 [IQR 27,008–64,266], p <0.001). In contrast, while the incidence of postoperative complications (low vs. intermediate vs. high; 22.0 vs. 19.2 vs. 13.0 %, p <0.001) and subsequent failure-to-rescue (low vs. intermediate vs. high; 16.6 vs. 24.7 vs. 15.1 %, p <0.001) was lower at high-volume hospitals, costs associated with “rescue” were substantially higher at high-volume hospitals (low vs. intermediate vs. high; $39,289 vs. $36,157 vs. $48,559, both p <0.001). Conclusions: Compared with lower volume hospitals, improved outcomes among patients who developed a complication at high-volume hospitals were associated with an increased cost.
AB - Background: Although proposed as a means for quality improvement, little is known regarding the economic consequences of volume-based referral. The objective of the current study was to investigate the relationship between inpatient costs and hospital volume. Methods: Patients undergoing elective liver surgery were identified using the Nationwide Inpatient Sample from 2001 to 2012. Multivariable hierarchical regression analyses were performed to calculate and compare risk-adjusted costs and postoperative outcomes across hospital volume terciles. Results: A total of 27,813 patients underwent surgery at 2207 hospitals. Although costs were comparable across the three volume groups (all p > 0.05), patients who developed a postoperative complication incurred a higher overall cost (complication vs. no complication; median costs $17,974 [IQR 13,865–25,623] vs. $41,731 [IQR 27,008–64,266], p <0.001). In contrast, while the incidence of postoperative complications (low vs. intermediate vs. high; 22.0 vs. 19.2 vs. 13.0 %, p <0.001) and subsequent failure-to-rescue (low vs. intermediate vs. high; 16.6 vs. 24.7 vs. 15.1 %, p <0.001) was lower at high-volume hospitals, costs associated with “rescue” were substantially higher at high-volume hospitals (low vs. intermediate vs. high; $39,289 vs. $36,157 vs. $48,559, both p <0.001). Conclusions: Compared with lower volume hospitals, improved outcomes among patients who developed a complication at high-volume hospitals were associated with an increased cost.
KW - Complication
KW - Costs
KW - Hospital variation
KW - Liver surgery
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U2 - 10.1007/s11605-015-3071-1
DO - 10.1007/s11605-015-3071-1
M3 - Article
C2 - 26768005
AN - SCOPUS:84954313351
SN - 1091-255X
SP - 1
EP - 8
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
ER -