title: Impact of hospital volume and specialization on the cost of orbital trauma care.
abstract: OBJECTIVE
  To examine the impact of hospital volume and specialization on the cost of orbital trauma care.
  
  
  METHODS
  Comparative case series and database study.
  
  
  METHODS
  Four hundred ninety-nine patients who underwent orbital reconstruction at either a high-volume regional eye trauma center, its academic parent institution, or all other hospitals in Maryland between 2004 and 2009.
  
  
  METHODS
  We used a publicly available database of hospital discharge data to identify the study population's clinical and cost characteristics. Multivariate models were developed to determine the impact of care setting on hospital costs while controlling for patient demographic and clinical variables.
  
  
  METHODS
  Mean hospital costs accrued during hospital admission for orbital reconstruction in 3 separate care settings.
  
  
  RESULTS
  Almost half (n = 248) of all patients received surgical care at the regional eye trauma center and had significantly lower adjusted mean hospital costs ($6194; 95% confidence interval [CI], $5709-$6719) compared with its parent institution ($8642; 95% CI, $7850-$9514) and all other hospitals ($12,692; 95% CI, $11,467-$14,047). A subpopulation analysis selecting patients with low comorbidity scores also was performed. The eye trauma center continued to have lower adjusted costs ($4277; 95% CI, $4112-$4449) relative to its parent institution ($6595; 95% CI, $5838-$7451) and other hospitals ($7150; 95% CI, $5969-$8565).
  
  
  CONCLUSIONS
  Higher volume and specialization seen at a regional eye trauma center are associated with lower costs in the surgical management of orbital trauma.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: John J
authors.initials: JJ
authors.lastname: Koo
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jiangxia
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Carol B
authors.initials: CB
authors.lastname: Thompson
authors.affiliation: Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Shannath L
authors.initials: SL
authors.lastname: Merbs
authors.affiliation: Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Plastic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: mgrant@jhmi.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Grant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005131:Eye Injuries / Q000191:economics* / Q000601:surgery; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data*; D009915:Orbit / Q000293:injuries*; D019651:Plastic Surgery Procedures / Q000191:economics*; D013038:Specialization / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000191:economics; D055815:Young Adult