L. E. Kuo1, T. Uribe-Leitz2, S. Lipsitz2, A. Haider1,2 1Brigham and Women’s Hospital,Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA
Background:It is well established that high-volume hospitals (HVH) have improved outcomes for various types of operations. In 2015, three major health systems adopted the “volume pledge,” restricting performance of 10 operation types to only high-volume hospitals (HVH) within their systems. However, the frequency of HVH for these procedures at a national level is unknown. Our objective was to assess the proportion of operations performed at HVH and patient characteristics associated with receiving care at these institutions.
Methods: Healthcare Cost and Utilization Project 2014 state inpatient databases (SID) from 18 widely geographically distributed states were utilized. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify the 10 operation types with known improved outcomes associated with HVH: bariatric surgery, carotid artery stenting, complex aortic surgery, esophageal cancer resection, total hip replacement, total knee replacement, lung cancer resection, mitral valve repair, pancreatic cancer resection, and rectal cancer resection. Hospital identifiers included in the SIDs assigned each operation to a hospital. Based on published volume pledge thresholds, each hospital was determined to be an LVH or HVH for each operation type. The number of operations performed at HVH versus LVH was calculated for each operation type. Patient characteristics (age, gender, race, median household income quartile, primary payer, and rural/suburban/urban) associated with receiving an operation at HVH were determined for each operation type using univariate analysis. Multivariate regression analyses were performed adjusting for significant covariates.
Results:The majority of esophageal cancer (72%), lung cancer (51%) and rectal cancer (61%) resections were performed at LVH. The vast majority of bariatric surgery (96%), complex aortic surgery (87%), total hip replacement (87%) and total knee replacement operations (94%) were performed at HVH. For bariatric surgery (60.3%), total hip replacement (56%) and total knee replacement (71%), the majority of performing hospitals were HVH, while for all other operation types, the majority of performing hospitals are LVH. See Table 1. For each of the 10 operation types, there were patient characteristics associated with receiving care at an HVH, and some persisted on multivariate analysis. However, there were no trends consistent between operation types.
Conclusion:The majority of esophageal cancer, lung cancer and rectal cancer patients are treated at LVH. The majority of hospitals performing the operations studied are not HVH. There remains significant opportunity to centralize these operations to improve patient outcomes.
