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Impact of Hospital Volume on Outcomes for Laparoscopic Adhesiolysis for Small Bowel Obstruction
Abstract Background Volume-to-outcome data has been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the lea...
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| Published in: | The Journal of surgical research 2017-06, Vol.214, p.23-31 |
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| creator | Jean, Raymond A., MD O'Neill, Kathleen M., MD Pei, Kevin Y., MD Davis, Kimberly A., MD, MBA, FACS |
| description | Abstract Background Volume-to-outcome data has been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of institutional procedural volume on length of stay, outcomes, and costs in laparoscopic lysis of adhesions for small bowel obstructions. Materials and Methods The Nationwide Inpatient Sample (NIS) dataset between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the period, and high volume hospitals were designated as those performing greater than five LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. Length of stay (LOS), cost, and total charges were reported as means with standard deviation and median values. P |
| doi_str_mv | 10.1016/j.jss.2017.02.045 |
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Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of institutional procedural volume on length of stay, outcomes, and costs in laparoscopic lysis of adhesions for small bowel obstructions. Materials and Methods The Nationwide Inpatient Sample (NIS) dataset between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the period, and high volume hospitals were designated as those performing greater than five LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. Length of stay (LOS), cost, and total charges were reported as means with standard deviation and median values. P<0.05 was considered significant. Results A total of 9,111 discharges were selected, which was representative of 43,567 weighted discharges nationally between 2000 and 2013. Over the study period, there has been a 450% increase in the number of LLOA performed. High volume hospitals had significantly shorter LOS (mean 4.92 days (SE 0.13); median 3.6) compared to low volume hospitals (mean 5.68 (SE 0.06); median 4.5). In multivariate analysis, high volume status was associated with a decreased LOS of 0.72 days (p <0.0001) as compared to low volume status. Other significant predictors for decreased LOS included decreased age, decreased comorbidity, and the absence of small bowel resection. There was no significant association between volume status and total charges in multivariate or univariate models, but high volume hospitals were associated with lower costs in multivariate models by approximately $984 (p=0.017). Conclusions This study demonstrates that high hospital volume was associated with decreased length of stay for LLOA in SBO. Although volume was not associated with differences in total charges, there was a small decrease in hospital costs.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2017.02.045</identifier><identifier>PMID: 28624050</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adhesiolysis ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Databases, Factual ; Female ; Hospital Costs - statistics & numerical data ; Hospital volume ; Hospitals, High-Volume ; Hospitals, Low-Volume ; Humans ; Intestinal Obstruction - economics ; Intestinal Obstruction - etiology ; Intestinal Obstruction - surgery ; Intestine, Small - surgery ; Laparoscopic lysis of adhesions ; Laparoscopy - economics ; Length of Stay - economics ; Length of Stay - statistics & numerical data ; Linear Models ; Male ; Middle Aged ; Minimally invasive surgery ; Multivariate Analysis ; SBO ; Small bowel obstruction ; Surgery ; Tissue Adhesions - complications ; Tissue Adhesions - economics ; Tissue Adhesions - surgery ; Treatment Outcome ; United States ; Young Adult</subject><ispartof>The Journal of surgical research, 2017-06, Vol.214, p.23-31</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-4944e5bbcfd1b0068f1fad8bfb212e11b1bc41b3322456cb5d1a48b3e87a24df3</citedby><cites>FETCH-LOGICAL-c408t-4944e5bbcfd1b0068f1fad8bfb212e11b1bc41b3322456cb5d1a48b3e87a24df3</cites><orcidid>0000-0002-2382-2491</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28624050$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jean, Raymond A., MD</creatorcontrib><creatorcontrib>O'Neill, Kathleen M., MD</creatorcontrib><creatorcontrib>Pei, Kevin Y., MD</creatorcontrib><creatorcontrib>Davis, Kimberly A., MD, MBA, FACS</creatorcontrib><title>Impact of Hospital Volume on Outcomes for Laparoscopic Adhesiolysis for Small Bowel Obstruction</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Abstract Background Volume-to-outcome data has been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of institutional procedural volume on length of stay, outcomes, and costs in laparoscopic lysis of adhesions for small bowel obstructions. Materials and Methods The Nationwide Inpatient Sample (NIS) dataset between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the period, and high volume hospitals were designated as those performing greater than five LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. Length of stay (LOS), cost, and total charges were reported as means with standard deviation and median values. P<0.05 was considered significant. Results A total of 9,111 discharges were selected, which was representative of 43,567 weighted discharges nationally between 2000 and 2013. Over the study period, there has been a 450% increase in the number of LLOA performed. High volume hospitals had significantly shorter LOS (mean 4.92 days (SE 0.13); median 3.6) compared to low volume hospitals (mean 5.68 (SE 0.06); median 4.5). In multivariate analysis, high volume status was associated with a decreased LOS of 0.72 days (p <0.0001) as compared to low volume status. Other significant predictors for decreased LOS included decreased age, decreased comorbidity, and the absence of small bowel resection. There was no significant association between volume status and total charges in multivariate or univariate models, but high volume hospitals were associated with lower costs in multivariate models by approximately $984 (p=0.017). Conclusions This study demonstrates that high hospital volume was associated with decreased length of stay for LLOA in SBO. Although volume was not associated with differences in total charges, there was a small decrease in hospital costs.</description><subject>Adhesiolysis</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hospital Costs - statistics & numerical data</subject><subject>Hospital volume</subject><subject>Hospitals, High-Volume</subject><subject>Hospitals, Low-Volume</subject><subject>Humans</subject><subject>Intestinal Obstruction - economics</subject><subject>Intestinal Obstruction - etiology</subject><subject>Intestinal Obstruction - surgery</subject><subject>Intestine, Small - surgery</subject><subject>Laparoscopic lysis of adhesions</subject><subject>Laparoscopy - economics</subject><subject>Length of Stay - economics</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally invasive surgery</subject><subject>Multivariate Analysis</subject><subject>SBO</subject><subject>Small bowel obstruction</subject><subject>Surgery</subject><subject>Tissue Adhesions - complications</subject><subject>Tissue Adhesions - economics</subject><subject>Tissue Adhesions - surgery</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Young Adult</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kU-LFDEQxYMo7jj6AbxIjl66TaXT_xCEdVF3YWAOq15Dkq5g2nSnTbqV-fZmmNWDB09FUe89qN8j5CWwEhg0b8ZyTKnkDNqS8ZKJ-hHZAevromva6jHZMcZ5ITomrsizlEaW976tnpIr3jVcsJrtiLybFmVWGiy9DWlxq_L0a_DbhDTM9LitJkyYqA2RHtSiYkgmLM7Q6-EbJhf8KbnL9X5S3tP34Rd6etRpjZtZXZifkydW-YQvHuaefPn44fPNbXE4frq7uT4URrBuLUQvBNZaGzuAZqzpLFg1dNpqDhwBNGgjQFcV56JujK4HUKLTFXat4mKw1Z68vuQuMfzYMK1ycsmg92rGsCUJPUAGBRnMnsBFavI3KaKVS3STiicJTJ65ylFmrvLMVTIuM9fsefUQv-kJh7-OPyCz4O1FgPnJnw6jTMbhbHBwEc0qh-D-G__uH7fxbnZG-e94wjSGLc6ZngSZskHen4s99wptxVjf1tVvRGKeYw</recordid><startdate>20170615</startdate><enddate>20170615</enddate><creator>Jean, Raymond A., MD</creator><creator>O'Neill, Kathleen M., MD</creator><creator>Pei, Kevin Y., MD</creator><creator>Davis, Kimberly A., MD, MBA, FACS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2382-2491</orcidid></search><sort><creationdate>20170615</creationdate><title>Impact of Hospital Volume on Outcomes for Laparoscopic Adhesiolysis for Small Bowel Obstruction</title><author>Jean, Raymond A., MD ; O'Neill, Kathleen M., MD ; Pei, Kevin Y., MD ; Davis, Kimberly A., MD, MBA, FACS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-4944e5bbcfd1b0068f1fad8bfb212e11b1bc41b3322456cb5d1a48b3e87a24df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adhesiolysis</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Hospital Costs - statistics & numerical data</topic><topic>Hospital volume</topic><topic>Hospitals, High-Volume</topic><topic>Hospitals, Low-Volume</topic><topic>Humans</topic><topic>Intestinal Obstruction - economics</topic><topic>Intestinal Obstruction - etiology</topic><topic>Intestinal Obstruction - surgery</topic><topic>Intestine, Small - surgery</topic><topic>Laparoscopic lysis of adhesions</topic><topic>Laparoscopy - economics</topic><topic>Length of Stay - economics</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally invasive surgery</topic><topic>Multivariate Analysis</topic><topic>SBO</topic><topic>Small bowel obstruction</topic><topic>Surgery</topic><topic>Tissue Adhesions - complications</topic><topic>Tissue Adhesions - economics</topic><topic>Tissue Adhesions - surgery</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jean, Raymond A., MD</creatorcontrib><creatorcontrib>O'Neill, Kathleen M., MD</creatorcontrib><creatorcontrib>Pei, Kevin Y., MD</creatorcontrib><creatorcontrib>Davis, Kimberly A., MD, MBA, FACS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jean, Raymond A., MD</au><au>O'Neill, Kathleen M., MD</au><au>Pei, Kevin Y., MD</au><au>Davis, Kimberly A., MD, MBA, FACS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Hospital Volume on Outcomes for Laparoscopic Adhesiolysis for Small Bowel Obstruction</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2017-06-15</date><risdate>2017</risdate><volume>214</volume><spage>23</spage><epage>31</epage><pages>23-31</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Abstract Background Volume-to-outcome data has been studied in several complex surgical procedures, demonstrating improved outcomes at higher volume centers. Laparoscopic lysis of adhesions (LLOA) for small bowel obstruction (SBO) may result in better outcomes, but there is no information on the learning curve for this potentially complex case. This study evaluates the effect of institutional procedural volume on length of stay, outcomes, and costs in laparoscopic lysis of adhesions for small bowel obstructions. Materials and Methods The Nationwide Inpatient Sample (NIS) dataset between 2000 and 2013 was queried for discharges for a diagnosis of SBO involving LLOA in adult patients. Patients with intra-abdominal malignancy and evidence of any other major surgical procedure during hospitalization were excluded. The procedural volume per hospital was calculated over the period, and high volume hospitals were designated as those performing greater than five LLOA per year. Patient characteristics were described by hospital volume status using stratified cluster sampling tabulation and linear regression methods. Length of stay (LOS), cost, and total charges were reported as means with standard deviation and median values. P<0.05 was considered significant. Results A total of 9,111 discharges were selected, which was representative of 43,567 weighted discharges nationally between 2000 and 2013. Over the study period, there has been a 450% increase in the number of LLOA performed. High volume hospitals had significantly shorter LOS (mean 4.92 days (SE 0.13); median 3.6) compared to low volume hospitals (mean 5.68 (SE 0.06); median 4.5). In multivariate analysis, high volume status was associated with a decreased LOS of 0.72 days (p <0.0001) as compared to low volume status. Other significant predictors for decreased LOS included decreased age, decreased comorbidity, and the absence of small bowel resection. There was no significant association between volume status and total charges in multivariate or univariate models, but high volume hospitals were associated with lower costs in multivariate models by approximately $984 (p=0.017). Conclusions This study demonstrates that high hospital volume was associated with decreased length of stay for LLOA in SBO. Although volume was not associated with differences in total charges, there was a small decrease in hospital costs.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28624050</pmid><doi>10.1016/j.jss.2017.02.045</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2382-2491</orcidid></addata></record> |
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| subjects | Adhesiolysis Adolescent Adult Aged Aged, 80 and over Databases, Factual Female Hospital Costs - statistics & numerical data Hospital volume Hospitals, High-Volume Hospitals, Low-Volume Humans Intestinal Obstruction - economics Intestinal Obstruction - etiology Intestinal Obstruction - surgery Intestine, Small - surgery Laparoscopic lysis of adhesions Laparoscopy - economics Length of Stay - economics Length of Stay - statistics & numerical data Linear Models Male Middle Aged Minimally invasive surgery Multivariate Analysis SBO Small bowel obstruction Surgery Tissue Adhesions - complications Tissue Adhesions - economics Tissue Adhesions - surgery Treatment Outcome United States Young Adult |
| title | Impact of Hospital Volume on Outcomes for Laparoscopic Adhesiolysis for Small Bowel Obstruction |
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