[Does hospital volume correlate with surgical process time? : Retrospective analysis of the five most common procedures for visceral surgery, trauma and orthopedic surgery and gynecology/obstetrics from the benchmarking program of the Berufsverband Deutscher Anästhesisten (BDA), Berufsverband Deutscher Chirurgen (BDC) and Verband für OP-Management (VOPM)].
Korreliert die Leistungsmenge eines Krankenhauses mit der chirurgischen Prozesszeit? : Retrospektive Analyse der jeweils fünf häufigsten Prozeduren aus den Bereichen Viszeralchirurgie, Unfall‑/orthopädische Chirurgie und Gynäkologie/Geburtshilfe aus dem Benchmarking-Programm von BDA, BDC und VOPM.
Benchmarking
Digestive System Surgical Procedures
Female
Gynecology
Health Services Research
Hospital Charges
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Obstetrics
Operative Time
Orthopedic Procedures
Orthopedics
Pregnancy
Retrospective Studies
Surgical Procedures, Operative
/ statistics & numerical data
Hospital routine data
Hospital volume
Minimum volume threshold
Operating room efficiency
Surgical procedure time
Journal
Der Anaesthesist
ISSN: 1432-055X
Titre abrégé: Anaesthesist
Pays: Germany
ID NLM: 0370525
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
05
09
2018
accepted:
05
02
2019
revised:
01
02
2019
pubmed:
22
3
2019
medline:
12
6
2020
entrez:
22
3
2019
Statut:
ppublish
Résumé
Minimum volume thresholds for specific surgical procedures in German hospitals were established in 2004 but remain controversial. For the first time, this study investigated the relationship between hospital performance volume and surgical procedure duration in a multicenter approach. The question here was whether a concentration on frequently performed procedures leads to a reduction in surgical process times. In a retrospective analysis, the 5 most common procedures from visceral, trauma/orthopedic and gynecological/obstetrics surgery were examined in hospitals participating in a benchmarking program. For each procedure performed between 2013 and 2015, hospitals were divided into 4 groups depending on the hospital volume provided. The average surgical duration of incision to suture time was calculated between the group with "very low" hospital volume and the other three groups ("low", "high" and "very high"). OR cases from 75 hospitals were analyzed. The number of included cases per procedure ranged from 31,940 to 2705. The average number of operations performed in a specific procedure was 3-4 times higher in high-volume hospitals compared to very low-volume hospitals. A linear relationship between hospital volume and surgical process time only appeared to be clearly seen in laparoscopic cholecystectomy, appendectomy and arthroscopic meniscus surgery: a higher case load led to a reduction in incision to suture time. For the other procedures, the surgical process times were inconsistent between the hospital groups. The case volume only appeared to have a direct but limited influence on incision to suture times in laparoscopic and arthroscopic procedures. Overall, the hospital performance volume appeared to be of subordinate importance in terms of OR-economics.
Sections du résumé
BACKGROUND
Minimum volume thresholds for specific surgical procedures in German hospitals were established in 2004 but remain controversial. For the first time, this study investigated the relationship between hospital performance volume and surgical procedure duration in a multicenter approach. The question here was whether a concentration on frequently performed procedures leads to a reduction in surgical process times.
METHODS
In a retrospective analysis, the 5 most common procedures from visceral, trauma/orthopedic and gynecological/obstetrics surgery were examined in hospitals participating in a benchmarking program. For each procedure performed between 2013 and 2015, hospitals were divided into 4 groups depending on the hospital volume provided. The average surgical duration of incision to suture time was calculated between the group with "very low" hospital volume and the other three groups ("low", "high" and "very high").
RESULTS
OR cases from 75 hospitals were analyzed. The number of included cases per procedure ranged from 31,940 to 2705. The average number of operations performed in a specific procedure was 3-4 times higher in high-volume hospitals compared to very low-volume hospitals. A linear relationship between hospital volume and surgical process time only appeared to be clearly seen in laparoscopic cholecystectomy, appendectomy and arthroscopic meniscus surgery: a higher case load led to a reduction in incision to suture time. For the other procedures, the surgical process times were inconsistent between the hospital groups.
CONCLUSION
The case volume only appeared to have a direct but limited influence on incision to suture times in laparoscopic and arthroscopic procedures. Overall, the hospital performance volume appeared to be of subordinate importance in terms of OR-economics.
Identifiants
pubmed: 30895350
doi: 10.1007/s00101-019-0559-1
pii: 10.1007/s00101-019-0559-1
doi:
Types de publication
Journal Article
Langues
ger
Sous-ensembles de citation
IM
Pagination
218-227Références
Gesundheitswesen. 2017 Oct;79(10):823-834
pubmed: 27050140
JAMA Surg. 2014 Feb;149(2):119-23
pubmed: 24336902
N Engl J Med. 1979 Dec 20;301(25):1364-9
pubmed: 503167
N Engl J Med. 2011 Jun 2;364(22):2128-37
pubmed: 21631325
Health Serv Res. 2012 Apr;47(2):756-69
pubmed: 22091561
Ann Surg. 1999 Sep;230(3):414-29; discussion 429-32
pubmed: 10493488
Am J Surg. 1999 Jan;177(1):28-32
pubmed: 10037304
Anesthesiology. 2005 Aug;103(2):401-5
pubmed: 16052123
Scand J Urol. 2013 Dec;47(6):483-90
pubmed: 23590830
Am J Surg. 2016 Jan;211(1):59-63
pubmed: 26542187
Med Care. 1984 Feb;22(2):115-25
pubmed: 6422168
BMJ Open. 2017 Sep 6;7(9):e016184
pubmed: 28882913
Anaesthesist. 2007 Oct;56(10):1060-6
pubmed: 17726589
Science. 1974 Mar 8;183(4128):922-32
pubmed: 17756742
Anesthesiology. 2005 Aug;103(2):225-8
pubmed: 16052103
Med Care. 2011 Dec;49(12):1076-81
pubmed: 22002649
Surg Innov. 2016 Apr;23(2):142-7
pubmed: 26209630
Dtsch Arztebl Int. 2013 Apr;110(14):237-43
pubmed: 23616816
Arch Surg. 2004 Apr;139(4):366-9; discussion 369-70
pubmed: 15078701
Anesthesiology. 2005 Aug;103(2):391-400
pubmed: 16052122
N Engl J Med. 2002 Apr 11;346(15):1128-37
pubmed: 11948273
J Bone Joint Surg Am. 2017 Sep 20;99(18):1547-1553
pubmed: 28926384
Dtsch Arztebl Int. 2014 Aug 18;111(33-34):549-55
pubmed: 25220064