Temporal trends and volume-outcome associations after traumatic brain injury: a 12-year study in Taiwan.
OBJECTIVE
The purpose of this study was to evaluate temporal trends in traumatic brain injury (TBI); the impact of hospital volume and surgeon volume on length of stay (LOS), hospitalization cost, and in-hospital mortality rate; and to explore predictors of these outcomes in a nationwide population in Taiwan.


METHODS
This population-based patient cohort study retrospectively analyzed 16,956 patients who had received surgical treatment for TBI between 1998 and 2009. Bootstrap estimation was used to derive 95% confidence intervals for differences in effect sizes. Hierarchical linear regression models were used to predict outcomes.


RESULTS
Patients treated in very-high-volume hospitals were more responsive than those treated in low-volume hospitals in terms of LOS (-0.11; 95% CI -0.20 to -0.03) and hospitalization cost (-0.28; 95% CI -0.49 to -0.06). Patients treated by high-volume surgeons were also more responsive than those treated by low-volume surgeons in terms of LOS (-0.19; 95% CI -0.37 to -0.01) and hospitalization cost (-0.43; 95% CI -0.81 to -0.05). The mean LOS was 24.3 days and the average LOS for very-high-volume hospitals and surgeons was 61% and 64% shorter, respectively, than that for low-volume hospitals and surgeons. The mean hospitalization cost was US $7,292.10, and the average hospitalization cost for very-high-volume hospitals and surgeons was 19% and 22% lower, respectively, than that for low-volume hospitals and surgeons. Advanced age, male sex, high Charlson Comorbidity Index score, treatment in a low-volume hospital, and treatment by a low-volume surgeon were significantly associated with adverse outcomes (p < 0.001).


CONCLUSIONS
The data suggest that annual surgical volume is the key factor in surgical outcomes in patients with TBI. The results improve the understanding of medical resource allocation for this surgical procedure, and can help to formulate public health policies for optimizing hospital resource utilization for related diseases.
Department of Health Care Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
Hon-Yi
HY
Shi
Shiuh-Lin
SL
Hwang
King-Teh
KT
Lee
Chih-Lung
CL
Lin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data* / Q000639:trends*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011361:Professional Competence; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult