The Associations of Hospital Volume, Surgeon Volume, and Surgeon Experience with Complications and 30-Day Rehospitalization after Free Tissue Transfer: A National Population Study

Abstract

Background Greater provider volume is associated with better outcomes. There is, however, a paucity of evidence on volume-outcome associations for surgical complications and 30-day all-cause rehospitalization after free tissue transfer (FTT) or free flap. Surgical complications and frequent rehospitalization are important quality indicators that substantially hinder appropriate healthcare spending. We hypothesized that increased provider volume and surgeon experience are associated with lower complication and hospital readmission rates. Methods We conduct a retrospective cohort study of adults 18–64 years of age who underwent FTT. We examined 100% of all FTT operations between 2001 and 2012 using Taiwan’s national data. We used regression modeling to examine associations between volume and outcome. All of our models were adjusted for patient, surgeon, and hospital characteristics. Results Seventeen percent of FTT operations (4,201 out of 25,327) had complications. Infection was the most prevalent complication after FTT (70%) and 30-day rehospitalization rate was about 20%. Hospital volume was associated with small decrease in complications in FTT (OR=0.99; CI:0.99–0.99; p < 0.01). For surgeons, years of experience and not annual case volume decreased surgical complications (OR=0.98; CI=0.97–0.99; p=0.01). We did not find any association between hospital or surgeon volume, or surgeon’s years of experience and 30-day rehospitalization. Conclusions Higher-volume hospitals and more experienced surgeons were shown to have lower likelihood of complications after surgery. Hospital process and structure affect outcomes and reduce surgical complications. Reducing a 30-day rehospitalization may require a payment reform as it demands a coordinated care pre and post hospital discharge.

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

“…In general, postoperative complications are reported to be associated with hospital volume in several types of disease [9]. Recently, investigations of not only hospital volume, but also surgeon volume, have shed light on surgery for gastrointestinal cancer, emergency surgery and other surgeries [10][11][12][13]. With regard to gastric cancer, Coupland et al recently reported that increasing hospital volume was associated with lower mortality, suggesting that further centralization of esophageal and gastric cancer surgical services was warranted in England [14].…”

Complications in Rhinoplasty: A Literature Review and Comparison with a Survey of Consent Forms

“…In any operation, increasing volume typically, though not always, improves results and decreases complication rates. [18][19][20] Though one may argue, busier surgeons also have more referrals from other physicians to perform secondary surgery. This has not been specifically addressed for rhinoplasty, however.…”

Modern Plastic Surgical Practice: Technical Competence Alone Is Not Enough

“…7 Indeed, Mahmoudi and colleagues showed that the risk of postoperative complications after free flap surgery was lower in high-volume and more experienced surgeons. 8 The well-documented volume-outcome ratio provided further, emphasises the importance of technical skills with evidences supporting lower risk of operative death for patients treated at a high volume center. 9 The lower mortality rate may, however, in part be explained by superior multidisciplinary care at the high volume centere and patient selection.…”