title: Impact of hospital and surgeon volumes in the management of complicated portal hypertension: review of a statewide database in Florida.
abstract: Mortality after complex surgical procedures has been shown to be inversely related to hospital volume. The purpose of this study was to determine whether these findings are applicable to radiologic and surgical procedures for complicated portal hypertension. The Agency for Healthcare Administration for the State of Florida database was queried to determine outcomes after transjugular intrahepatic stent shunts (TIPS) or surgical shunts from 2000 to 2003. A total of 1486 patients underwent either TIPS (1321) or surgical shunts (165). Natural breakpoints occurred at two and six procedures per year were correlated with survival for surgical shunts but not TIPS. Overall mortality was not different between TIPS and surgical shunts (11.0 vs. 12.7%, P = 0.51); however, the cost of TIPS was significantly lower (62,000 +/- 58.5 vs. 107,000 +/- 97.8, P < 0.001) as well as the length of hospitalization (9 +/- 9.0 days vs. 15 days +/- 12.6 days, P < 0.001). Surgical procedures for complicated portal hypertension are rapidly being replaced by TIPS. Like with other complex procedures, outcomes are related to hospital volume.
authors.affiliation: Division of Surgical Oncology, Brody School of Medicine, Department of Surgery, Eastern Carolina University, Greenville, North Carolina, USA.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Dana
authors.initials: D
authors.lastname: Osborne
authors.forename: Steven C
authors.initials: SC
authors.lastname: Agle
authors.forename: Micheal M
authors.initials: MM
authors.lastname: McNally
authors.forename: Brian
authors.initials: B
authors.lastname: Boe
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D005431:Florida / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011170:Portasystemic Shunt, Surgical / Q000191:economics / Q000401:mortality* / Q000706:statistics & numerical data*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D016019:Survival Analysis