title: Effect of provider volume on resource utilization for surgical procedures of the knee.
abstract: Operating-room time and patient disposition on discharge are important determinants of healthcare resource utilization and cost. We examined the relation between these determinants and hospital/surgeon volume for anterior cruciate ligament (ACL) reconstruction and meniscectomy procedures. Patients undergoing ACL reconstruction (18,390 cases) and meniscectomy (123,012 cases) were extracted from the State Ambulatory Surgery Databases for the years 1997-2000. Surgeon and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the adjusted association between surgeon and hospital volume and patient discharge status and operating-room time. Patients undergoing ACL reconstruction or meniscectomy performed by low-volume surgeons were significantly more likely to be non-routinely discharged as compared to high-volume surgeons (adjusted odds ratio 3.5, 95% confidence interval 1.7-7.2 for ACL reconstruction; adjusted odds ratio 2.0, 95% confidence interval 1.6-2.3 for meniscectomy). The mean operating-room time for performing ACL reconstruction or meniscectomy was significantly higher in low- and intermediate-volume surgeons and hospitals as compared to high-volume surgeons and hospitals (p < or = 0.001). High-volume providers utilize healthcare resources more efficiently. Our findings may help surgeons and hospitals in optimizing resource utilization and cost for routinely-performed ambulatory surgery procedures.
authors.affiliation: Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC, USA. Nitin_Jain@hms.harvard.edu
authors.forename: Nitin
authors.initials: N
authors.lastname: Jain
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.forename: Anoop
authors.initials: A
authors.lastname: Shankar
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Ahluwalia
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D000070600:Tibial Meniscus Injuries; D014481:United States