Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons

Analysis of the Maryland Health Service Cost Review Commission Database

Azah A. Althumairi, Joseph K. Canner, Michael Gorin, Sandy H Fang, Susan L Gearhart, Elizabeth C. Wick, Bashar Safar, Trinity Bivalacqua, Jonathan Efron

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)46-52
Number of pages7
JournalAmerican Surgeon
Volume82
Issue number1
StatePublished - Jan 1 2016

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Pelvic Exenteration
Health Care Costs
High-Volume Hospitals
Health Services
Databases
Operating Rooms
Costs and Cost Analysis
Intensive Care Units
Length of Stay
Surgeons
Quality of Health Care
Demography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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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.",
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