The Impact of Hospital Surgical Volume on Healthcare Utilization Outcomes After Pediatric Thyroidectomy.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
accepted:
05
01
2022
pubmed:
4
2
2022
medline:
5
4
2022
entrez:
3
2
2022
Statut:
ppublish
Résumé
A positive relationship between an individual surgeon's operative volume and clinical outcomes after pediatric and adult thyroidectomy is well-established. The impact of a hospital's pediatric operative volume on surgical outcomes and healthcare utilization, however, are infrequently reported. We investigated associations between hospital volume and healthcare utilization outcomes following pediatric thyroidectomy in Canada's largest province, Ontario. Retrospective analysis of administrative and health-related population-level data from 1993 to 2017. A cohort of 1908 pediatric (<18 years) index thyroidectomies was established. Hospital volume was defined per-case as thyroidectomies performed in the preceding year. Healthcare utilization outcomes: length of stay (LOS), same day surgery (SDS), readmission, and emergency department (ED) visits were measured. Multivariate analysis adjusted for patient-level, disease and hospital-level co-variates. Hospitals with the lowest volume of pediatric thyroidectomies, accounted for 30% of thyroidectomies province-wide and performed 0-1 thyroidectomies/year. The highest-volume hospitals performed 19-60 cases/year. LOS was 0.64 days longer in the highest, versus the lowest quartile. SDS was 83% less likely at the highest, versus the lowest quartile. Hospital volume was not associated with rate of readmission or ED visits. Increased ED visits were, however, associated with male sex, increased material deprivation, and rurality. Increased hospital pediatric surgical volume was associated with increased LOS and lower likelihood of SDS. This may reflect patient complexity at such centers. In this cohort, low-volume hospitals were not associated with poorer healthcare utilization outcomes. Further study of groups disproportionately accessing the ED post-operatively may help direct resources to these populations.
Sections du résumé
BACKGROUND
A positive relationship between an individual surgeon's operative volume and clinical outcomes after pediatric and adult thyroidectomy is well-established. The impact of a hospital's pediatric operative volume on surgical outcomes and healthcare utilization, however, are infrequently reported. We investigated associations between hospital volume and healthcare utilization outcomes following pediatric thyroidectomy in Canada's largest province, Ontario.
METHODS
Retrospective analysis of administrative and health-related population-level data from 1993 to 2017. A cohort of 1908 pediatric (<18 years) index thyroidectomies was established. Hospital volume was defined per-case as thyroidectomies performed in the preceding year. Healthcare utilization outcomes: length of stay (LOS), same day surgery (SDS), readmission, and emergency department (ED) visits were measured. Multivariate analysis adjusted for patient-level, disease and hospital-level co-variates.
RESULTS
Hospitals with the lowest volume of pediatric thyroidectomies, accounted for 30% of thyroidectomies province-wide and performed 0-1 thyroidectomies/year. The highest-volume hospitals performed 19-60 cases/year. LOS was 0.64 days longer in the highest, versus the lowest quartile. SDS was 83% less likely at the highest, versus the lowest quartile. Hospital volume was not associated with rate of readmission or ED visits. Increased ED visits were, however, associated with male sex, increased material deprivation, and rurality.
CONCLUSIONS
Increased hospital pediatric surgical volume was associated with increased LOS and lower likelihood of SDS. This may reflect patient complexity at such centers. In this cohort, low-volume hospitals were not associated with poorer healthcare utilization outcomes. Further study of groups disproportionately accessing the ED post-operatively may help direct resources to these populations.
Identifiants
pubmed: 35113199
doi: 10.1007/s00268-022-06456-6
pii: 10.1007/s00268-022-06456-6
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1082-1092Informations de copyright
© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
Références
Sosa JA, Tuggle CT, Wang TS et al (2008) Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab 93(8):3058–3065
doi: 10.1210/jc.2008-0660
Adam MA, Thomas S, Youngwirth L et al (2017) Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 265(2):402–407
doi: 10.1097/SLA.0000000000001688
Hauch A, Al-Qurayshi Z, Randolph G et al (2014) Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol 21(12):3844–3852
doi: 10.1245/s10434-014-3846-8
Krishnamurthy VD, Jin J, Siperstein A et al (2016) Mapping endocrine surgery: workforce analysis from the last six decades. Surgery 159(1):102–112
doi: 10.1016/j.surg.2015.08.024
Sosa JA, Bowman H, Tielsch J, Powe NR et al (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330
doi: 10.1097/00000658-199809000-00005
Stavrakis AI, Ituarte PHG, Ko CY et al (2007) Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142(6):887–899
doi: 10.1016/j.surg.2007.09.003
Al-Qurayshi Z, Randolph GW, Srivastav S (2015) Outcomes in endocrine cancer surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope 126(3):775–781
doi: 10.1002/lary.25606
Al-Qurayshi Z, Hauch A, Srivastav S et al (2016) A national perspective of the risk, presentation, and outcomes of pediatric thyroid cancer. JAMA Otolaryngol Head Neck Surg 142(5):472–477
doi: 10.1001/jamaoto.2016.0104
Drews JD, Cooper JN, Onwuka EA (2019) The relationships of surgeon volume and specialty with outcomes following pediatric thyroidectomy. J Pediatr Surg 54(6):1226–1232
doi: 10.1016/j.jpedsurg.2019.02.033
Meltzer C, Hull M, Sundang A et al (2019) Association between annual surgeon total thyroidectomy volume and transient and permanent complications. JAMA Otolaryngol Head Neck Surg 145(9):830–838
doi: 10.1001/jamaoto.2019.1752
Breuer C, Tuggle C, Solomon D et al (2013) Pediatric thyroid disease: when is surgery necessary, and who should be operating on our children? J Clin Res Pediatr Endocrinol 5(Suppl 1):79–85
pubmed: 23149389
pmcid: 3608013
Francis GL, Waguespack SG, Bauer AJ et al (2015) Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25(7):716–759
doi: 10.1089/thy.2014.0460
Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137
doi: 10.1056/NEJMsa012337
McAteer JP, LaRiviere CA, Drugas GT et al (2013) Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery. JAMA Pediatr 167(5):468–468
doi: 10.1001/jamapediatrics.2013.25
Youngwirth LM, Adam MA, Thomas SM et al (2018) Pediatric thyroid cancer patients referred to high-volume facilities have improved short-term outcomes. Surgery 163(2):361–366
doi: 10.1016/j.surg.2017.09.042
Weiner JP, Abrams C (2011) The Johns Hopkins ACG® system technical reference guide version 10.0. John Hopkins Bloomberg School of Public Health
Arim RG, Guevremont A, Kohen DE et al (2017) Exploring the Johns Hopkins aggregated diagnosis groups in administrative data as a measure of child health. Int J Child Health Hum Dev 10(1):19–29
Maltenfort MG, Chen Y, Forrest CB (2019) Prediction of 30-day pediatric unplanned hospitalizations using the Johns Hopkins Adjusted Clinical Groups risk adjustment system. Kamolz L-P, ed. PLoS ONE 14(8):e0221233
Matheson FI, Van Ingen T (2018) 2016 Ontario marginalization index: user guide. St. Michael’s Hospital. Joint Publication with Public Health Ontario, Toronto, ON
Austin PC (2017) A tutorial on multilevel survival analysis: methods. Models Appl Int Stat Rev 85(2):185–203
doi: 10.1111/insr.12214
Keegan THM, Grogan RH, Parsons HM et al (2015) Sociodemographic disparities in differentiated thyroid cancer survival among adolescents and young adults in California. Thyroid 25(6):635–648
doi: 10.1089/thy.2015.0021