J. T. Adler1, A. P. Loehrer1, E. A. Mort1, K. D. Lillemoe1, D. C. Chang1 1Massachusetts General Hospital,Boston, MA, USA
Introduction: Healthcare delivery and utilization varies internationally. It is unknown how much inpatient procedure utilization varies among developed countries, especially among discretionary procedures. We hypothesized the rates of discretionary admissions are higher in the US than other developed countries.
Methods: Previously published seven discretionary surgical procedures (appendectomy, abdominal aortic aneurysm [AAA] repair, carotid endarterectomy [CEA], open reduction and internal fixation [ORIF] of the femur, hysterectomy, and prostatectomy), were analyzed. The Global Comparators dataset from Dr Foster Intelligence, a global hospital benchmarking collaborative that includes all inpatient admissions to 18 academic medical centers in Australia, Holland, the United Kingdom (UK), and the United States (US) from 2008-2013 was used. With the UK as a reference, multivariable logistic regressions were performed for hospital admissions for each procedure versus all other hospital admissions, adjusting for age and gender differences.
Results: A total of 6,956,354 admissions were analyzed. Utilization patterns varied widely (Table); a higher OR indicates more common utilization of admissions for a particular procedure. The US had the highest rates of inpatient admissions for four procedures: AAA repair (OR 2.60, p<0.001), CEA (OR 2.81, P<0.001), hysterectomy (OR 1.98, p<0.001), and prostatectomy (OR 5.13, p<0.001). US also had significantly higher, although not the highest, rate for ORIF (OR 1.49, p<0.001) than UK. In contrast, US had lower rates for appendectomy (OR 0.79, p<0.001) relative to UK, both of which had the highest rates in Australia.
Conclusions: International utilization patterns vary considerably, with significantly higher rates of inpatient admissions for discretionary surgical procedures in the US. This association was especially true for resource-intensive procedures, but not for less-intensive operations. Analyses like this may lead to better understanding of healthcare system performance.
