title: Outcomes after the regionalization of major surgical procedures in the Alberta Capital Health Region (Edmonton).
abstract: OBJECTIVE
  To evaluate the impact of regionalization on the outcomes of 16 surgical procedures performed in the Capital Health Region (Edmonton) of Alberta.
  
  
  METHODS
  A computer search of hospital discharge abstracts coded for the Canadian Institute for Health Information.
  
  
  METHODS
  Two major hospitals in Edmonton.
  
  
  METHODS
  The study population comprised 9250 patients (9727 procedures [4524, pre-regionalization, 5203 post-regionalization]) who underwent any of 16 major procedures in the 2 years before and the 2 years after restructuring.
  
  
  METHODS
  Demographic data, Charlson's comorbidity index, number of urgent and emergent cases, death rate, average length of hospital stay and the readmission rate.
  
  
  RESULTS
  The post-regionalization patient group was slightly older, had a higher comorbidity index, and fewer urgent and emergent cases. The case volume increased by 15%, and 43.6% of patients used some form of community-based health care services. The median length of hospital stay decreased from 8.0 days pre-regionalization to 7.0 days post-regionalization (p < 0.001). Overall and for specific procedures the death rate was unchanged (3.1% pre-regionalization, 2.4% post-regionalization, p = 0.06). The readmission rates were similar for both groups (8.0% versus 7.0%).
  
  
  CONCLUSIONS
  The consolidation of these 16 major surgical procedures had minimal impact on death and readmission rates even though patients in the post-regionalization group were slightly older and had greater comorbidity. There was a significant decline in the length of hospital stay, which occurred nationally over the same period, and a corresponding increase in the use of community-based services.
authors.affiliation: Department of Surgery and Capital Health Authority, University of Alberta, Edmonton. shamilto@cha.ab.ca
authors.forename: S M
authors.initials: SM
authors.lastname: Hamilton
authors.forename: W C
authors.initials: WC
authors.lastname: Johnston
authors.forename: D C
authors.initials: DC
authors.lastname: Voaklander
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D005260:Female; D006764:Hospitals, Community / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*