R. A. Jean1, K. M. O’Neill1, K. Pei2, K. A. Davis2 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale University School Of Medicine,Department Of Surgery, Division Of General Surgery, Trauma And Surgical Critical Care,New Haven, CT, USA
Introduction: Volume to outcome data has been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of procedural volume on length of stay, outcomes, and costs in laparoscopic lysis of adhesions for small bowel obstructions.
Methods: The Nationwide Inpatient Sample (NIS) dataset between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the time period, and high volume hospitals were designated as those performing greater than 25 weighted LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. Length of stay (LOS), cost, and total charges were reported as means with standard deviation and median values. P<0.05 was considered significant.
Results:A total of 9,111 discharges were selected, which was representative of 43,567 weighted discharges nationally between 2000 and 2013. Over the study period, there has been a 450% increase in the number of LLOA performed. High volume hospitals had significantly shorter LOS (mean 4.92 days (SE 0.13); median 3.6) compared to low volume hospitals (mean 5.68 (SE 0.06); median 4.5). In multivariate analysis, high volume status was associated with a decreased LOS of 0.72 days (p <0.0001) as compared to low volume status. Other significant predictors for decreased LOS included decreased age, decreased comorbidity, and the absence of small bowel resection. There was no significant association between volume status and total charges in multivariate or univariate models but, high volume hospitals were associated with lower costs in multivariate models by approximately $984 (p=0.017).
Conclusion:This study demonstrates that high hospital volume was associated with decreased length of stay for LLOA in SBO. Although volume was not associated with differences in total charges, there was a small decrease in hospital costs.
