title: Hospital volume is related to clinical and economic outcomes of esophageal resection in Maryland.
abstract: BACKGROUND
  Previous studies have documented a relationship between hospital volume and perioperative and economic outcomes. Our objective was to determine the effect of hospital volume on outcomes of esophageal resection.
  
  
  METHODS
  Statewide database was analyzed for patients who underwent esophageal resection in Maryland (n = 1,136 patients) from 1984 to 1999. Multivariate regression was used to determine the association of hospital volume with in-hospital mortality, length of stay, and charges after adjusting for case mix and time period.
  
  
  RESULTS
  Unadjusted in-hospital mortality rates were lower in high volume hospitals (2.7%) than medium (12.7%) and low (16%) volume hospitals (p < 0.001). High hospital volume was associated with (1) fivefold reduction in the risk of death (odds ratio, 0.21; 95% confidence interval, 0.10 to 0.42; p < 0.001); (2) a 6-day (95% confidence interval, 5 to 7 days; p < 0.001) reduction in length of stay; and (3) $11,673 (95% confidence interval, $9,504 to $12,841; p < 0.001) decrease in hospital charges. Conclusions. Hospitals that perform high volumes of esophageal resection have superior clinical and economic outcomes. By referring these patients to high volume centers, we may improve quality and reduce costs.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-4605, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Dimick
authors.forename: S M
authors.initials: SM
authors.lastname: Cattaneo
authors.forename: P A
authors.initials: PA
authors.lastname: Lipsett
authors.forename: P J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: R F
authors.initials: RF
authors.lastname: Heitmiller
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics; D004938:Esophageal Neoplasms / Q000191:economics* / Q000601:surgery; D016629:Esophagectomy / Q000191:economics*; D019317:Evidence-Based Medicine / Q000191:economics; D005260:Female; D006276:Health Facility Size / Q000191:economics*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008396:Maryland; D008875:Middle Aged; D012017:Referral and Consultation / Q000191:economics; D016896:Treatment Outcome