Assessing the Costs Associated with Volume-Based Referral for Hepatic Surgery

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Faiz Gani, Timothy M Pawlik

Abstract

Although proposed as a means for quality improvement, little is known regarding the economic consequences of volume-based referral. The objective of the current study was to investigate the relationship between inpatient costs and hospital volume. Patients undergoing elective liver surgery were identified using the Nationwide Inpatient Sample from 2001 to 2012. Multivariable hierarchical regression analyses were performed to calculate and compare risk-adjusted costs and postoperative outcomes across hospital volume terciles. A total of 27,813 patients underwent surgery at 2207 hospitals. Although costs were comparable across the three volume groups (all p > 0.05), patients who developed a postoperative complication incurred a higher overall cost (complication vs. no complication; median costs $17,974 [IQR 13,865-25,623] vs. $41,731 [IQR 27,008-64,266], p < 0.001). In contrast, while the incidence of postoperative complications (low vs. intermediate vs. high; 22.0 vs. 19.2 vs. 13.0 %, p < 0.001) and subsequent failure-to-rescue (low vs. intermediate vs. high; 16.6 vs. 24.7 vs. 15.1 %, p < 0.001) was lower at high-volume hospitals, costs associated with "rescue" were substantially higher at high-volume hospitals (low vs. intermed...Continue Reading

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Citations

Nov 5, 2016·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Faiz GaniTimothy M Pawlik
Jul 1, 2017·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Faiz GaniTimothy M Pawlik
Aug 2, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Gregory T KennedySunil Singhal
Jul 25, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Rohan ShahTimothy M Pawlik
Jun 2, 2018·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Jay J IdreesTimothy M Pawlik
Dec 30, 2020·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Savio George BarretoJohn A Windsor
Dec 18, 2020·Global Health & Medicine·Eloisa FranchiGuido Torzilli
Mar 10, 2019·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Faiz GaniTimothy M Pawlik

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