Variability in elective day-surgery rates between Belgian hospitals - Analyses of administrative data explained by surgical experts

Leroy, Roos; Camberlin, Cécile; Lefèvre, Mélanie; Heede, Koen Van den; Voorde, Carine Van de; Beguin, Claire

doi:10.1016/j.ijsu.2017.07.075

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Other determinants that influence a development of day surgery in Slovakia may be revealed by researching causal relations between provided components. The given findings correspond with results of the study by Leroy et al [4], who emphasized a high level of performance variability among hospitals. The authors also highlighted a significance of a feedback that should provide relevant data of day surgery performances in order to realize a benchmarking and a monitoring of multiple quality indicators.…”

Section: Discussionsupporting

confidence: 91%

“…The goal of continuous improvement of the day-to-day surgery processes is to return a patient to normal life as quickly as possible. Leroy et al [4] pointed out in their study the variability in the choice of day surgery interventions between Belgian hospitals in the years 2011-2013. The authors used administrative data analyses which were realized by surgical experts.…”

Section: Overview Of the Research Studiesmentioning

confidence: 99%

“…This high variability in performance between hospitals may reflect a lack of expertise of some anaesthesia teams in managing perioperative pain outside the hospital, as well as the experience of surgeons with particular surgical procedures, patient co-morbidity, etc. Few studies have been concerned with examining the variability among day surgeries from a regional perspective and revealing factors that may be significant in the insufficient progression of day surgery in a country [2][3][4]. The investigation of these facts is very important in setting relevant policies and regional strategic health plans, in designing health care expenditure in the context of demographic aging populations, and in assessing the effectiveness of the health system as a whole [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Exploration of Disparities in Regions and Specialized Fields of Day Surgery System

Gavurová

Khouri

Koróny

2020

IJERPH

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The main objective of this paper was to find similarities among eight Slovak regions from the viewpoint of five specialized day surgery fields and among specialized day surgery fields from the viewpoint of Slovak regions on the basis of day surgery operated and hospitalized patient counts. Day surgery data of paediatric patients and of adult patients from the National Health Information Centre during the years 2009–2017 were used. Correspondence analysis in two dimensions of the Slovak regions and of specialized day surgery fields was applied in order to achieve the paper’s objective. The Košice Region differs most from the overall national average in both groups of paediatric day surgery. This is caused by its largest proportions in the fields of Gynaecology (29.7%) and Urology (48.0%) (operated patients), and in the fields of Gynaecology (60.5%) and Surgery (21.6%) (hospitalized patients). The most different specialized day surgery fields from overall average are: Urology (operated paediatric patients), Gynaecology (hospitalized paediatric patients), Otorhinolaryngology (operated adult patients) and Ophthalmology (hospitalized adult patients). Urogenital system day surgery procedures (Gynaecology, Urology) are separated from other three fields (i.e., Surgery, Ophthalmology, Otorhinolaryngology) either in the first or in the second dimension of the singular value matrix decomposition.

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Section: Discussionsupporting

confidence: 91%

Section: Overview Of the Research Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploration of Disparities in Regions and Specialized Fields of Day Surgery System

Gavurová

Khouri

Koróny

2020

IJERPH

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“…), hospitalizations are always reimbursed, regardless of whether the admission was justified [ 4 ]. Whereas several authors analyzed the potential move towards ambulatory surgery [ 5 – 8 ], little has been proposed to substitute hospitalizations by ambulatory care, especially in medicine and pediatrics.…”

Section: Introductionmentioning

confidence: 99%

Measuring medically unjustified hospitalizations in Switzerland

Eggli

Halfon

Piaget-Rossel

et al. 2022

BMC Health Serv Res

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Background Inappropriate use of acute hospital beds is a major topic in health politics. We present here a new approach to measure unnecessary hospitalizations in Medicine and Pediatrics. Methods The necessity of a hospital admission was determined using explicit criteria related to the recorded diagnoses. Two indicators (i.e. “unjustified” and “sometimes justified” stays) were applied to more than 800,000 hospital stays and a random sample of 200 of them was analyzed by two clinicians, using routine data available in medical statistics. The validation of the indicators focused on their precision, validity and adjustment, as well as their usefulness (i.e. interest and risk of abuse). Results Rates, adjusted for case mix (i.e. age of patient, admission planned or not), showed statistically significant differences among hospitals. Only 6.5% of false positives were observed for “unjustified stays” and 17% for “sometimes justified stays”. Respectively 7 and 12% of stays had an unknown status, due to a lack of sufficiently precise data. Considering true positives only, almost one third of medical and pediatric stays were classified as not strictly justified from a medical point of view in Switzerland. Among these stays, about one fifth could have probably been avoided without risk. To enable a larger ambulatory shift, recommendations were made to strengthen the ambulatory care, notably regarding post-emergency follow-up, cardiac and pulmonary functions’ monitoring, pain management, falls prevention, and specialized at-home services that should be offered. Conclusion We recommend using “unjustified stays” and “sometimes justified stays” indicators to monitor inappropriate hospitalizations. The latter could help the planning of reinforced ambulatory care measures to pursue the ambulatory shift. Nonetheless, we clearly advise against the use of these two indicators for hospitals financing purposes.

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“…They are apparent between the particular hospitals and even between the surgeons. This consistent fact is a motive for a study by Leroy et al, aiming at an investigation of a variability in the performance of day surgery among the hospitals in the Kingdom of Belgium [14]. A total of 486 medical procedure data are analysed, along with the expert meetings with medical staff and, in particular, anaesthesiologists from 54 hospitals.…”

Section: Introductionmentioning

confidence: 99%

Quantification of Similarity Relationships According to Parameters of Day Surgery System

Gavurová

Kováč

Bejtkovský

2019

IJERPH

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Performing day surgery should minimise a number of hospitalisation cases, but its use is determined by many factors. It takes advantage of the latest advances in surgical care, enabling better use of highly costly specialised operating room equipment. This analysis of the day surgery system of the Slovak Republic stands on an examination of the five specialised fields-surgery, gynaecology, ophthalmology, otorhinolaryngology, and urology. The explored period covers the years 2009 to 2017. The whole analysis is divided into the two sections-the youth category and for the adult category. For each case, a hospitalisation ratio is computed. A map visualisation supports the analysis outcome. A quantification of the similarity relationships between the regions is done according to a Euclidean distance approach and it is illustrated through the heat map. The centremost region is the Žilina Region with distance at a level of 1.9821, meaning that it performs as the most similar region to a development of a hospitalisation ratio in the whole Slovak Republic regarding all the examined aspects. The findings introduce an important platform for a creation of regional and national health plans in the area of healthcare provision for the population of the country.Day surgery is one form of saving financial resources of health insurance companies, but its implementation is very expensive. In the recent years, the question of the economic efficiency of introduction of day surgery as well as the transformation of hospital departments into day surgery units has also come to the attention of research teams. This is also confirmed by the results of the study by Gabriel et al., who are concerned with an optimisation of the costs of day surgery performance and a process of finding opportunities for better organisation together with economic and personnel utilisation [3]. These authors also provide an interesting impetus for our subsequent research-an examination the risk factors and causalities associated with surgery and mortality.The conditions for performing day surgery are different for children than for adults, and they are set in a stricter regime. It also affects the type of diagnoses and comorbidities that are numerous for elderly patients. The same affect can be seen also among the youth population [4]. However, the benefits of day surgery in children outweigh the disadvantages for most children and families. Day surgery reduces the risk of nosocomial infections, the risk of anxiety, disturbed sleep, and so forth. For families, there is minimal disruption to working patterns and childcare needs. It also significantly reduces the economic burden on society. Every day surgery procedure not only provides considerable money savings, but also brings efficiency in medical practice in the healthcare system.Public policies should make greater efforts to achieve higher transparency and effective accountability, especially in public healthcare systems with a wide range of public and private healthcare service providers. According to many ...

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Variability in elective day-surgery rates between Belgian hospitals - Analyses of administrative data explained by surgical experts

Cited by 18 publications

References 9 publications

Exploration of Disparities in Regions and Specialized Fields of Day Surgery System

Exploration of Disparities in Regions and Specialized Fields of Day Surgery System

Measuring medically unjustified hospitalizations in Switzerland

Quantification of Similarity Relationships According to Parameters of Day Surgery System

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