A. A. Nair1, T. Mokhtari1, J. M. Morton2 1Stanford University School Of Medicine,Palo Alto, CA, USA 2Stanford University,General Surgery,Palo Alto, CA, USA
Introduction:
Accreditation for complex surgery has been traditionally based upon surgical volume. This volume initiative had evidence from a direct relationship between hospital volume and surgical outcomes across a variety of procedures. However, the variability of performance among low-volume hospitals has not been thoroughly explored. We investigated whether low volume hospitals are able to reach the same surgical outcomes standards set by high-volume centers.
Methods:
Using ICD -9 codes and the 2010 National Inpatient Survey, we analyzed 194 hospitals performing laparoscopic Roux-en-Y gastric bypass, laparoscopic gastric sleeve gastrectomy, and laparoscopic gastric banding. Hospitals were divided into low volume (LV) hospitals (< 50 cases annually) and high volume (HV) hospitals (≥ 50 cases annually) based on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program standards (MBSAQIP). All patients with a prior history of cancer, IBD, UC, and FAP were excluded from analysis. All continuous variables were compared using t-test and weighted to represent national estimates. Statistical significance was defined as p < .05.
Results:
Surgical outcomes at 110 LV hospitals and 84 HV hospitals were analyzed. Both groups had similar proportions of complex patients based on the Charlson Comorbidity Index (score ≥ 1: .555 vs. .560, p = .8891). Most strikingly, 20 (18%) low volume hospitals met or exceeded the standards set by high volume centers in length of stay, complications, mortality, and discharge to home. On average, patients at HVH had a shorter inpatient stay (2.42 days vs. 4.21 days, p=.<.001) and had significantly less complications (.2211 vs. .5271, p=.0003) with a smaller proportion of patients experiencing any complications (15% vs 25%, p=.001). No significant difference was found in mortality (.07% vs. .34%, p=.11) or discharge to home (94.6% vs. 91.8%, p=.281).
Conclusion:
Our analysis suggests that a certain number of low volume hospitals are able to achieve the surgical outcomes of high volume hospitals.
