The effect of surgeon volume and hospital characteristics on in-hospital outcome after ureteral reimplantation in children

Abstract

The aim of this study was to examine the association between surgeon and hospital characteristics on in-hospital outcome after ureteral reimplantation in children. Patients<18 years undergoing vesicoureteral reimplantation (n=3,109) were identified in Kids' Inpatient Database, an administrative database containing discharge records from 27 states during 2000 in the US. Based on patient volume in 2000, surgeons were designated as low volume (<11 procedures), medium volume (11-20 procedures) and high volume (>20 procedures) surgeons. Length of stay and hospital charges were analyzed using multivariate linear regression analysis. A significant association between shorter length of stay and higher surgeon volume (p=0.02) was observed that was independent of children's hospital status, hospital volume and other hospital characteristics. Length of stay was 20% shorter when the procedure was performed by the highest volume surgeons compared to when performed by the lowest. No significant effect of surgeon volume on hospital charges, however, was observed. Higher surgeon volume was associated with shorter length of stay but no difference in hospital charges among children undergoing vesicoureteral reimplantation.

Why do high-volume hospitals achieve better outcomes? A systematic review about intermediate factors in volume–outcome relationships

“…(arrow 2) Do structura l and process characteristics lead to better patient outcomes? (arrow 3) Categ ory 1: compli ance to eviden ce based process es of ca re Kurlansky [36] No a No Yes Bozic [33] Yes b Yes Yes Auerbach [39] Yes No Yes Auerbach [3 8] No Yes Yes Auerbach [37] No No No Holl enbeck [32] Yes Yes Yes Birkmeyer [21] Yes Yes No Categ ory 2: level of spec ialization Mercado [25] Yes Yes Yes Chung [26] Yes Yes Yes Park [22] Yes No No Vernoo ij [24] Yes Yes Yes Billi ngsley [41] Yes Yes No Dickste in [42] Yes Yes No Freeman [40] Yes Yes No Chen [23] Yes No No Joynt [2 8] Yes Yes Yes Thiema nn [20] Yes Yes No Shaw [2 7] Yes Yes Yes Categ ory 3: hosp ital l evel fac tors Hickey [44] Yes Yes No Jose ph [45] No Yes Yes Chung [43] Yes Yes No Holl enbeck [4 6] No Yes No Billi ngsley [2 9] Yes Yes Yes Elti ng [30] Yes Yes Yes Solomon [47] Yes Yes No Ross [31] Yes Yes Yes Thiema nn [20] Yes Yes No…”

“…-Physician certification [40] -Neonatal intensive care level [26] -Surgeon specialty training (gynecologic, oncologists/ gynecologists, general surgeons, and other specialty) [25] -Surgeon specialty (general versus urologist) [22] -Level of specialization (general, semi-specialized or specialized) [24] -Treatment by board certified colorectal surgeons and surgeon's age [41] -Children's hospital status [42] -Surgeon specialty [23] -Physician specialty (cardiologist, internist, generalist) [28] -Surgeon designation (designated general surgeon, specialist surgeon) [27] -Specialty of attending physician [20] Hospital level factors (10 studies)…”

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

“…Three urology studies met criteria. One study 38 examined hospital volume as an exposure in patients undergoing bladder exstrophy repair, and 2 studies 39,40 examined both hospital and surgeon volume in patients undergoing ureteral reimplantation. Strong riskadjustment models were used.…”