A. Gupta1, R. Chaudhary1,2,3, A. W. Davis1, A. Krasnova1,2,3, S. Haring1,3,4, C. K. Zogg1,2,3, M. A. Morris1,3, A. H. Haider1,2,3, E. B. Schneider1,3,4,5 5Johns Hopkins University School Of Medicine,Baltimore, MD, USA 1Brigham And Women’s Hospital,Center For Surgery And Public Health,,Boston, MA, USA 2Harvard School Of Public Health,Boston, MA, USA 3Harvard School Of Medicine,Brookline, MA, USA 4Johns Hopkins Bloomberg School Of Public Health,Health Policy And Management,Baltimore, MD, USA
Introduction:
Surgeon-specific annual procedure volume has been associated with improved outcomes in a variety of complex surgical procedures. The relationship between surgeon volume and outcomes for patients undergoing orthognathic surgery has not been reported. We examined the relationship between surgeon volume and hospital length of stay (LOS), and total hospital charges for patients undergoing the two most common orthognathic procedures, namely segmental osteoplasty/osteotomy of maxilla or open osteoplasty/osteotomy of mandibular ramus.
Methods:
All patients undergoing the aforementioned procedures as in-patients were selected from the 2002 to 2009 Nationwide Inpatient Sample. Year-specific annual procedure volumes were calculated for each surgeon and dichotomized into low- and high volume groups (<10 vs. ≥ 10 procedures/year respectively). The relationship between year-specific annual volume and the likelihood of extended patient LOS (defined as LOS ≥ 75th percentile) was examined using multivariable logistic regression, adjusting for patient and hospital-level factors. Possible provider-volume related differences in total charges were examined using a generalized linear model, with a log-link and gamma distribution also adjusting for patient and hospital-level factors.
Results:
Among the 3,705 patient admissions eligible for inclusion, age ranged between 4 days to 80 years, with 68.7% of patients being between 15-30 years of age. Annual surgeon volume ranged from 1 to 36 with a mean of 6 (SD=7) procedures/year. Overall, 81.2% of procedures were performed by low-volume surgeons and 46.8% of surgeons performed 3 or fewer procedures annually. In univariable analyses, patient demographics did not differ between high and low volume providers. Also, no surgeon-volume-related differences were observed between teaching and non-teaching hospitals. Patients treated by high volume surgeons demonstrated 34% lower odds of experiencing extended LOS (OR 0.66 95% CI: 0.46-0.95) after adjusting for patient demographic factors, insurance status, comorbidities, and hospital characteristics (rural vs. urban, teaching status and bed-size). There was no association between surgeon volume and total hospital charges after adjusting for potential confounders.
Conclusion:
Regionalization of patients to high volume surgeons/centers for surgical treatment has been recommended for specific subsets of surgical patients, including those with major trauma and requiring certain cardiac, cancer or gastric bypass procedures. Our findings suggest the possibility that similar regionalization strategies might reduce the likelihood of extended LOS for patients undergoing orthognathic procedures.