Hospital Volume, Length of Stay, and Readmission Rates in High-Risk Surgery
Annals of SurgeryPublished 1 August 2003Open access
Philip P. Goodney, Thérèse A. Stukel, F. Lee Lucas, Emily Finlayson, John D. Birkmeyer
Citations316
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Although hospital volume may be an important predictor of operative mortality, it is not associated with resource use as reflected by length of stay or readmission rates.
Abstract
Although hospital volume may be an important predictor of operative mortality, it is not associated with resource use as reflected by length of stay or readmission rates.
Keywords
Medicine
Journal of Chronic DiseasesA new method of classifying prognostic comorbidity in longitudinal studies: Development and validation
49,938 Citations1987Mary E. Charlson, Peter Pompei +2 more
The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
New England Journal of MedicineHospital Volume and Surgical Mortality in the United States
4,978 Citations2002John D. Birkmeyer, Andrea E. Siewers +6 more
Mortality decreased as volume increased for all 14 types of procedures, but the relative importance of volume varied markedly according to the type of procedure.
Annals of Internal MedicineIs Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature
1,680 Citations2002Ethan A. Halm, Clara Lee +1 more
A systematic review of the research evidence linking volume and outcome in health care is conducted, to summarize and describe the methodologic rigor of the existing literature, and to highlight the research and policy implications of these findings.
JAMAImpact of Hospital Volume on Operative Mortality for Major Cancer Surgery
1,654 Citations1998Colin B. Begg
The hypothesis that when complex surgical oncologic procedures are provided by surgical teams in hospitals with specialty expertise, mortality rates are lower is supported.
Annals of SurgeryThe Importance of Surgeon Experience for Clinical and Economic Outcomes From Thyroidectomy
1,101 Citations1998Julie Ann Sosa, Helen M. Bowman +4 more
Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy, and they were more likely to operate on patients with cancer.
Annals of Internal MedicineThe Distinction Between Cost and Charges
1,071 Citations1982Steven A. Finkler
The literature on economic efficiency in providing hospital services has been growing recently, but instead of measuring cost directly, studies use patient bills (charges) aa a proxy for cost as a measure of cost.
PubMedSelective referral to high-volume hospitals: estimating potentially avoidable deaths.
775 Citations2000R. Adams Dudley, Kirsten L. Johansen +3 more
Initiatives to facilitate referral of patients to HVHs have the potential to reduce overall hospital mortality in California for the conditions identified and to determine the extent to which selective referral is feasible and to examine the potential consequences.
Archives of SurgeryTen-Year Experience With 733 Pancreatic Resections
760 Citations2001James H. Balcom
There has been a significant decrease in LOS; this is the result of implementation of case management and clinical pathways, increasing case volume, decreasing incidence of delayed gastric emptying, and decreasing use of pylorus-preserving PD.
Controlled Clinical TrialsPublication bias and clinical trials
721 Citations1987Kay Dickersin, Simon Chan +3 more
It appears that nonpublication was primarily a result of failure to write up and submit the trial results rather than rejection of submitted manuscripts, implying the existence of a publication bias of importance both to meta-analysis and the interpretation of statistically significant positive trials.
American Journal of Public HealthThe accuracy of Medicare's hospital claims data: progress has been made, but problems remain.
717 Citations1992Elliot S. Fisher, Fredrick S. Whaley +5 more
Although some diagnoses and all major surgical procedures that were examined were accurately coded, the variability in the accuracy of diagnosis coding poses a problem that must be overcome if claims-based research is to achieve its full potential.
SurgeryVolume standards for high-risk surgical procedures: Potential benefits of the Leapfrog initiative
531 Citations2001John D. Birkmeyer, Emily Finlayson +1 more
If the Leapfrog volume standards are successfully implemented, employers and health-care purchasers could prevent many surgical deaths by requiring hospital volume standards for high-risk procedures.
Annals of SurgeryImportance of Hospital Volume in the Overall Management of Pancreatic Cancer
505 Citations1998Julie Ann Sosa, Helen M. Bowman +7 more
Patients with pancreatic cancer who are to be treated with curative or palliative procedures appear to benefit from referral to a high-volume provider, and increased hospital volume is associated with markedly decreased in-hospital mortality rates and a decreased or similar length of stay for all three types of procedures and with decreases or similar hospital charges for resections and stents.
Annals of SurgeryThe Effects of Regionalization on Cost and Outcome for One General High-Risk Surgical Procedure
475 Citations1995Toby A. Gordon, Gregg P. Burleyson +2 more
An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.
JAMAComorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality?
451 Citations1992Lisa I. Iezzoni
JNCI Journal of the National Cancer InstitutePublication Bias and Dissemination of Clinical Research
443 Citations1989Colin B. Begg, Jesse A. Berlin
Empiric studies have demonstrated that the induced bias is large and can have a serious impact on meta-analyses, in which data from several studies are aggregated, as well as on informal reviews.
JAMAThe Risks of Risk Adjustment
408 Citations1997Lisa I. lezzoni
This article examines severity measures used in states and regions to produce comparisons of risk-adjusted hospital death rates and concludes that Severity does not explain differences in death rates across hospitals.
JAMAHospital Characteristics and Quality of Care
399 Citations1992Emmett B. Keeler
Quality varies from state to state, but teaching, larger, and more urban hospitals have better quality in general than nonteaching, small, and rural hospitals.
Annals of SurgeryHospital Volume Can Serve as a Surrogate for Surgeon Volume for Achieving Excellent Outcomes in Colorectal Resection
394 Citations1999John W. Harmon, Daniel Tang +9 more
A skewed distribution of case volumes by surgeon was found in this study of patients who underwent resection for large bowel cancer in Maryland, with higher surgeon volume associated with significant improvement in all three outcomes (in-hospital death, length of stay, and cost).
JAMAThe risks of risk adjustment
380 Citations1997Lisa I. Iezzoni
Severity does not explain differences in death rates across hospitals, and severity measures used in states and regions to produce comparisons of risk-adjusted hospital death rates are examined.
Journal of Thoracic and Cardiovascular SurgeryEffect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer
341 Citations2000Stephen G. Swisher, Linda L. DeFord +9 more
Improved outcomes and decreased hospital use in hospitals that perform a large number of esophagectomies are demonstrated and support the concept of tertiary referral centers for such complex oncologic procedures as esophageal operations.
JAMAPositive-Outcome Bias and Other Limitations in the Outcome of Research Abstracts Submitted to a Scientific Meeting
304 Citations1998Michael L. Callaham
Positive-outcome bias was evident when studies were submitted for consideration and was amplified in the selection of abstracts for both presentation and publication, neither of which was strongly related to study design or quality.
New England Journal of MedicineEffects of Admission to a Teaching Hospital on the Cost and Quality of Care for Medicare Beneficiaries
300 Citations1999Donald H. Taylor, David J. Whellan +1 more
JAMASeverity-Adjusted Mortality and Length of Stay in Teaching and Nonteaching Hospitals
287 Citations1997Gary E. Rosenthal
Evidence is provided that hospital performance, as assessed by 2 commonly used indicators, may be higher in major teaching hospitals than for patients in minor teaching and nonteaching hospitals.
JAMADoes Inappropriate Use Explain Small-Area Variations in the Use of Health Care Services?
239 Citations1990Lucian L. Leape
It is concluded that little of the variation in the rates of use of these procedures can be explained by inappropriate use.
The Journal of ArthroplastyRelationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty
216 Citations1995Carlos J. Lavernia, Jose F. Guzman
Results showed that in primary arthroplasty, surgeons with a low volume of primary cases have a significantly higher mortality rate, higher average charges, and increased average length of hospital stay than in revision surgery.
PubMedHospital volume influences outcome in patients undergoing pancreatic resection for cancer.
194 Citations1996Robert E. Glasgow, Sean J. Mulvihill
This study supports the concept of regionalizing high risk procedures in general surgery, such as major pancreatic resection for cancer, by finding that high-volume providers had significantly decreased operative mortality, complication-associated mortality, patient resource use, and total charges and were more likely than low-volume centers to discharge patients to home.
Journal of the American College of SurgeonsComplex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes11No competing interests declared.
186 Citations1999Toby A. Gordon, Helen M. Bowman +8 more
It is demonstrated that increased hospital experience is associated with a marked decrease in hospital mortality and the decreased mortality at the high-volume provider was also associated with shorter lengths-of-stay and lower hospital charms.
The Journal of UrologyTHE EFFECT OF HOSPITAL VOLUME ON MORTALITY AND RESOURCE USE AFTER RADICAL PROSTATECTOMY
179 Citations2000Lars M. Ellison, John A. Heaney +1 more
Hospital volumes inversely related to in-hospital mortality, length of stay and total hospital charges after radical prostatectomy, and further study is necessary to examine the association of hospital volume with other important outcomes, including incontinence, impotence and long-term patient survival after radical Prostate cancer.
Journal of Vascular SurgeryInfluence of age and hospital volume on the results of carotid endarterectomy: A statewide analysis of 9918 cases
170 Citations1998Bruce A. Perler, Alan Dardik +3 more
CEA is a safe procedure in the majority of hospitals in contemporary practice, even among the very elderly, who may experience a longer length of stay and higher charges correlating with their documented greater medical complexity.
Annals of Internal MedicinePredicting Who Dies Depends on How Severity Is Measured: Implications for Evaluating Patient Outcomes
164 Citations1995Lisa I. Iezzoni, Arlene S. Ash +4 more
Predicting in-hospital death using four severity measures is focused on, and three major questions are asked: 1) How well do severity measures predict in- hospital death? 2) Do different severity Measures predict different likelihoods of death for the same patients? and 3) If so, what are the clinical characteristics of patients for whom very different likelihood of death are predicted by different severity measures?
Medical CareExplaining Geographic Variations
152 Citations1993Mark R. Chassin
This analysis explores the validity of the enthusiasm hypothesis using previously published data on carotid endarterectomy to propose a different explanation for geographic variations in the use of health care services, i.e., the enthusiasm hypotheses.
American Journal of Public HealthOvercoming potential pitfalls in the use of Medicare data for epidemiologic research.
148 Citations1990Elliot S. Fisher, John A. Baron +3 more
It is found that among Medicare enrollees, physician claims identify a small proportion of hip fracture cases which are not documented in the hospital discharge files, and this proportion varies by age, region, and state within the United States.
PubMedIllness severity and costs of admissions at teaching and nonteaching hospitals.
124 Citations1990Lisa I. Iezzoni, Michael Shwartz +4 more
Journal of Health EconomicsEffects of teaching on hospital costs
119 Citations1983Frank A. Sloan, Roger Feldman +1 more
Non-physician expense in major teaching hospitals is at most 20 percent higher than in non-teaching hospitals; the teaching effect is about half this for hospitals with more limited teaching programs, and results for ancillary service departments are consistent with those for the hospital as a whole.
Journal of the American College of CardiologyThe role of hospital volume in coronary artery bypass grafting: is more always better?11>Presented, in part, at the Annual Meeting of the American Heart Association in New Orleans, Louisiana, on November 13, 2000.
107 Citations2001Brahmajee K. Nallamothu, Sanjay Saint +4 more
Targeted regionalization of subjects at moderate risk or higher to high-volume hospitals would have resulted in an estimated 370 transfers and avoided 16 deaths; in contrast, full regionalization would have led to 2,029 transfers and prevented 20 deaths.
PubMedPotential benefits of regionalizing major surgery in Medicare patients.
103 Citations2000John D. Birkmeyer, F. L. Lucas +1 more
Even with conservative assumptions about reduction in surgical mortality likely to be achieved, the benefits of regionalizing major procedures in Medicare patients could be substantial and policymakers should focus on common procedures before less-common, high-risk operations.
PubMedThe effect of hospital volume on the in-hospital complication rate in knee replacement patients.
103 Citations1998E C Norton, Steven Garfinkel +5 more
Rather than uncontrolled expansion of knee surgery to small hospitals, decentralization to regional centers where at least about 50, and preferably about 100, operations per year are assured appears to be the optimal policy to reduce in-hospital complications.
JAMAIllness Severity and Costs of Admissions at Teaching and Nonteaching Hospitals
84 Citations1990Lisa I. Iezzoni
Journal of Epidemiology & Community HealthHospital volume, calendar age, and short term outcomes in patients undergoing repair of abdominal aortic aneurysms: the Ontario experience, 1988-92.
82 Citations1996Shi Wu Wen, Marko Šimunović +3 more
The relationship between hospital volume and mortality or morbidity was very modest and observed only for elective surgery, and the excess risk of postoperative death in ruptured as compared to unruptured aneurysms was substantially higher in older patients.
Health AffairsWill Volume-Based Referral Strategies Reduce Costs Or Just Save Lives?
81 Citations2002John D. Birkmeyer, Jonathan Skinner +1 more
The primary argument for volume-based referral strategies should be improving quality, not reducing costs, and the primary effect of these policies will be to redistribute surgical profits to bigger centers.
New England Journal of MedicineRelation between Surgeons' Practice Volumes and Geographic Variation in the Rate of Carotid Endarterectomy
80 Citations1989Lucian L. Leape, Rolla Edward Park +4 more
It is concluded that most of the geographic variation in the rate of carotid endarterectomy is caused by a few surgeons in high-use areas who perform large numbers of operations.
JAMAAccuracy in Recorded Diagnoses
62 Citations1992Stephen F. Jencks
In the last few years, major journals have published a growing number of articles in which recorded additional diagnoses play an important part in analysis, either to establish a clinical point or to assess additional diagnoses as a measure of clinical severity of illness.
International Journal for Quality in Health CareThe Policy Implications of Using Hospital and Physician Volumes as “Indicators” of Quality of Care in a Changing Health Care Environment
38 Citations1997Kathryn A. Phillips, Harold S. Luft
The policy implications of using hospital and physician volume information as an "indicator" of quality in a rapidly changing health care environment with new players and new incentives are examined.
Health AffairsUncovering the High Costs of Teaching Hospitals
38 Citations1986Frank A. Sloan, Joseph Valvona
For there to be informed public policy making, it is necessary to know what the cost differentials are, why they occur, and then to assess the advantages and deficiencies of alternative funding mechanisms.
PubMedThe hospital volume-outcome relationship in general thoracic surgery. Is the surgeon the critical determinant?
25 Citations2000Urschel Jd, Urschel Dm
Despite having a very low volume of thoracic surgical cases the community hospital had crude outcomes comparable to those reported from high volume tertiary hospitals, which suggests that the surgeon may be a more important factor in the hospital volume-outcome relationship than previously thought.
Journal of Vascular SurgeryA prospective study of discharge disposition after vascular surgery
22 Citations2001D. Scott Crouch, Robert B. McLafferty +6 more
Modifications in treatment strategies may improve independent living status after vascular surgery and decrease the intense use of extended care resources required for this patient population during recovery.
PubMedCost effectiveness of regionalization-further results for heart surgery.
21 Citations1981Steven A. Finkler
The results of the current study indicate that efficient production could be attained at a volume of 300 heart surgery patients per center per year.
PubMedMedicare home health agency utilization, 1984-1994.
20 Citations1999Gabriel Picone, Wilson Rm
The results show little evidence that Medicare home health services substitute for informal home care, though they may reduce the use of skilled nursing facility care.
Home Health Care Services QuarterlyState Variations in Home Health Expenditures and Utilization Under Medicare and Medicaid
15 Citations1986A. E. Benjamin
States vary considerably with respect to relative utilization, visits, and visit-expenditures under Medicare; and states vary in terms the role visits versus visit-reimbursements play in shaping overall costs.
Journal of Thoracic and Cardiovascular SurgeryRelationship of hospital size, case volume, and cost for coronary artery bypass surgery: Analysis of 12,774 patients operated on in Massachusetts during fiscal years 1995 and 1996
14 Citations2001David M. Shahian, Gerald J. Heatley +1 more
It is not possible to predict the relative cost of coronary bypass grafting at a given hospital based primarily on volume, and within the range of hospital size and case volume represented, there is no evidence that either variable is related to the cost of performing coronary bypass surgery.
Mayo Clinic ProceedingsPerformance Measurement in Pneumonia Care: Beyond Report Cards
11 Citations1998Michelle A. Josephson, William A. Agger +3 more
The findings suggest that hospital "report cards" based solely on outcome comparisons provide inadequate information and examination of variations in profiles of resource utilization can detect important differences in hospitals and can be used to guide continuous quality improvement efforts and ultimately improve hospital care.
AACN Clinical Issues Advanced Practice in Acute & Critical CareReducing Length of Stay in Patients Undergoing Open Heart Surgery: The University of Pittsburgh Experience
10 Citations1995Elisabeth George, Adelo A. Large
The development, use, and evaluation of the clinical pathway, one component of the case management model, was implemented at one university medical center in the coronary artery bypass surgical group and the role of the advanced nurse practitioner as the case manager is discussed.
