Detailed analysis of the impact of surgeon and hospital volume in microsurgical breast reconstruction

Abstract

Background Prior investigations of microsurgical breast reconstruction have not distinguished the effects of surgeon versus hospital volume and failed to address the effect of patient clustering. Our data‐driven analysis aims to determine the impacts of surgeon and hospital volume on outcomes of microsurgical breast reconstruction. Methods Nationwide Inpatient Sample (NIS) data from 2008 to 2011 was analyzed for patients who underwent microsurgical breast reconstruction. Volume‐outcome relationships were analyzed with restricted cubic spline analysis. A multivariable mixed‐effects logistic regression was used to account for patient clustering effect. Results A total of 5,404 NIS patients met inclusion criteria. High‐volume (HV) surgeons had a 59% decrease in the risk of inpatient complications, which became non‐significant after clustering correction. For HV hospitals, there was a 47% decrease in the risk of inpatient complications (odds ratio = 0.53; 95% confidence intervals 0.30, 0.91; p = 0.021) that was statistically significant with the clustering adjustment. Neither the volume‐cost relationship for surgeons nor hospitals remained statistically significant after accounting for clustering. Conclusions Hospital volume plays a significant impact on outcomes in microsurgical breast reconstruction, while surgeon volume has comparatively not shown to be similarly impactful. The complexity of care related to microsurgical breast reconstruction warrants equally complex and engineered health systems.

Cost-volume analysis of deep inferior epigastric artery perforator flaps for breast reconstruction in the United States

“…Although the relationship between high volume and improved outcomes is well documented in the existing literature, examination of this association among DIEP flap reconstructions remains limited. 12,13,25 In the present work, high procedural volume was associated with reduced rates of systemic complications, such as respiratory, infectious, and thrombotic events. However, we did not observe a significant association between center volume and procedural complications.…”

“…In congruence with our findings, Reid et al found increasing volume of all microsurgical breast reconstruction cases to be linked to lower costs. 25 The cost-effectiveness of complex operations at high-volume centers is likely due to more efficient intraoperative and postoperative care pathways established in experienced centers. Our findings may be particularly relevant in referral decisions and pay for performance paradigms.…”

National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients

“…Given the propensity of higher volume hospitals to receive referrals of more complicated cases, our finding that high-volume hospitals were significantly less likely to have surgical complications is additionally noteworthy ( P =0.014). This holds true across the literature for other surgical procedures, including various general surgical procedures, cardiac surgical procedures, overall microsurgical procedures, free flap breast reconstructive surgery, craniosynostosis surgery, and orthognathic surgery 1,24–26,28 . High-volume hospitals experiencing fewer surgical complications could be because of surgeon experience, established multidisciplinary teams, and optimized care pathways for these procedures.…”

“…When examining patient costs and hospital volume, this study found that patient admission charges related to orthognathic operations at high-volume hospitals were significantly less than other hospitals ( P <0.001). This trend has been seen in various general surgery and plastic surgery procedures 23–26 . However, when analyzing other craniofacial procedures, a national study on cleft palate repair was unable to demonstrate associations between hospital volume and costs 27 .…”

“…This trend has been seen in various general surgery and plastic surgery procedures. [23][24][25][26] However, when analyzing other craniofacial procedures, a national study on cleft palate repair was unable to demonstrate associations between hospital volume and costs. 27 Some of this could be attributed to case-mix index and severity of cleft pathology treated at higher volume hospitals.…”