Trends in Hospital Volume and Operative Mortality for High-Risk Surgery
By Jonathan F. Finks, N. Osborne, J. Birkmeyer. New England Journal of Medicine, 2011
1,298 citations recorded by the source corpus.
BACKGROUND There were numerous efforts in the United States during the previous decade to concentrate selected surgical procedures in high-volume hospitals. It remains unknown whether referral patterns for high-risk surgery have changed as a result and how operative mortality has been affected. METHODS We used national Medicare data to study patients undergoing one of eight different cancer and cardiovascular operations from 1999 through 2008. For each procedure, we examined trends in hospital volume and market concentration, defined as the proportion of Medicare patients undergoing surgery in the top decile of hospitals by volume per year. We used regression-based techniques to assess the effects of volume and market concentration on mortality over time, adjusting for case mix. RESULTS Median hospital volumes of four cancer resections (lung, esophagus, pancreas, and bladder) and of repair of abdominal aortic aneurysm (AAA) rose substantially. Depending on the procedure, higher hospital volumes were attributable to an increasing number of cases nationwide, an increasing market concentration, or both. Hospital volumes rose slightly for aortic-valve replacement but fell for coronary-artery bypass grafting and carotid endarterectomy. Operative mortality declined for all eight procedures, ranging from a relative decline of 8% for carotid endarterectomy (1.3% mortality in 1999 and 1.2% in 2008) to 36% for AAA repair (4.4% in 1999 and 2.8% in 2008). Higher hospital volumes explained a large portion of the decline in mortality for pancreatectomy (67% of the decline), cystectomy (37%), and esophagectomy (32%), but not for the other procedures. CONCLUSIONS Operative mortality with high-risk surgery fell substantially during the previous decade. Although increased market concentration and hospital volume have contributed to declining mortality with some high-risk cancer operations, declines in mortality with other procedures are largely attributable to other factors. (Funded by the National Institute on Aging.)
Subfields: Cardiology and Cardiovascular Medicine, Oncology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/36b9d47f499b3f260240a15ddd737c8a1a199c39
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Citations in the corpus
- Annual Report to the Nation on the Status of Cancer, 1975–2014, Featuring Survival (2017, background): “Lower surgical mortality may have been achieved through improvements in anesthesia and supportive care, institution of quality improvement programs, and regionalization of high-risk surgeries (78).”
- Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010 (2012, background): “Total knee arthroplasty is now among the most common major surgical procedures performed in the United States.(6) The increase in TKA can be viewed as an indication of the success of this procedure in safely reducing pain and improving functional status for an aging population.”
- Benchmarking Complications Associated with Esophagectomy (2017, background): “Reviews of national datasets from North America confirm that esophagectomy 30-day mortality remains above 5%.(1) National audits and meta-analyses have demonstrated that in-hospital and 90-day mortality more accurately reflect actual mortality associated with esophagectomy with in-hospital mortality”
- Nationwide Trends in the Performance of Inpatient Hysterectomy in the United States (2013, background): “This trend has predominantly been observed for procedures with a strong association between outcomes and surgical volume.(2) The hospital-level trends for hysterectomy have been similar to coronary artery bypass graft, also a procedure that has seen a rapid decline in use over the past decade.”