title: Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons: Analysis of the Maryland Health Service Cost Review Commission Database.
abstract: High volume hospitals (HVHs) and high volume surgeons (HVSs) have better outcomes after complex procedures, but the association between surgeon and hospital volumes and patient outcomes is not completely understood. Our aim was to evaluate the impact of surgeon and hospital volumes, and their interaction, on postoperative outcomes and costs in patients undergoing pelvic exenteration (PE) in the state of Maryland. A review of the Maryland Health Services Cost Review Commission database between 2000 and 2011 was performed. Patients were compared for demographics and clinical variables. The differences in length of hospital stay , length of intensive care unit (ICU) stay, operating room (OR) cost, and total cost were compared for surgeon volume and hospital volume controlling for all other factors. Surgery performed by HVS at HVH had the shortest ICU stay and lowest OR cost. When PE was performed by a low volume surgeon at an HVH, the OR cost and total cost were the highest and increased by $2,683 (P < 0.0001) and $16,076 (P < 0.0001), respectively. OR costs reduced when surgery was performed by an HVS at an HVH ($-1632, P = 0.008). PE performed by HVS at HVH is significantly associated with lower OR costs and ICU stay. We feel this is indicative of lower complication rates and higher quality care.
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Azah A
authors.initials: AA
authors.lastname: Althumairi
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Canner
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.forename: Sandy H
authors.initials: SH
authors.lastname: Fang
authors.forename: Susan L
authors.initials: SL
authors.lastname: Gearhart
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
authors.forename: Bashar
authors.initials: B
authors.lastname: Safar
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Efron
mesh_terms: D000368:Aged; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D061847:Hospitals, High-Volume; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010385:Pelvic Exenteration / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D066231:Surgeons / Q000706:statistics & numerical data; D016526:Workload