Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients

Hemalkumar Mehta, Abhishek D. Parmar, Deepak Adhikari, Nina P. Tamirisa, Francesca Dimou, Daniel Jupiter, Taylor S. Riall

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients. Materials and methods The study used Texas Medicare data (2000-2012), identifying high-volume surgeons as those performing ≥4 pancreatic resections/year, and high-volume hospitals as those performing ≥11 pancreatic resections/year, on Medicare patients. Three-level hierarchical logistic regression models were used to evaluate the relative effects of surgeon and hospital volumes on mortality and complications, after adjusting for case mix differences. Results There were 2453 pancreatic resections performed by 490 surgeons operating in 138 hospitals. Of the total, 4.5% of surgeons and 6.5% of hospitals were high volume. The overall 30-d mortality was 9.0%, and the 30-d complication rate was 40.6%. Overall, 8.9% of the variance in 30-d mortality was attributed to surgeon factors and 9.8% to hospital factors. For 30-d complications, 4.7% of the variance was attributed to surgeon factors and 1.2% to hospital factors. After adjusting for patient, surgeon, and hospital characteristics, high surgeon volume (odds ratio [OR] = 0.54, 95% confidence interval [CI], 0.33-0.87) and high hospital volume (OR = 0.52; 95% CI, 0.30-0.92) were associated with lower risk of mortality; high surgeon volume (OR = 0.71, 95% CI, 0.55-0.93) was also associated lower risk of 30-d complications. Conclusions Both hospital and surgeon factors contributed significantly to the observed variance in mortality, but only surgeon factors impacted complications.

Original languageEnglish (US)
Pages (from-to)326-334
Number of pages9
JournalJournal of Surgical Research
Volume204
Issue number2
DOIs
StatePublished - Aug 1 2016

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Medicare
Mortality
High-Volume Hospitals
Odds Ratio
Confidence Intervals
Surgeons
Logistic Models
Diagnosis-Related Groups

Keywords

  • Complications
  • Hospital volume
  • Mortality
  • Multilevel models
  • Pancreatic resection
  • Surgeon volume

ASJC Scopus subject areas

  • Surgery

Cite this

Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients. / Mehta, Hemalkumar; Parmar, Abhishek D.; Adhikari, Deepak; Tamirisa, Nina P.; Dimou, Francesca; Jupiter, Daniel; Riall, Taylor S.

In: Journal of Surgical Research, Vol. 204, No. 2, 01.08.2016, p. 326-334.

Research output: Contribution to journalArticle

Mehta, Hemalkumar ; Parmar, Abhishek D. ; Adhikari, Deepak ; Tamirisa, Nina P. ; Dimou, Francesca ; Jupiter, Daniel ; Riall, Taylor S. / Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients. In: Journal of Surgical Research. 2016 ; Vol. 204, No. 2. pp. 326-334.
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abstract = "Background Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients. Materials and methods The study used Texas Medicare data (2000-2012), identifying high-volume surgeons as those performing ≥4 pancreatic resections/year, and high-volume hospitals as those performing ≥11 pancreatic resections/year, on Medicare patients. Three-level hierarchical logistic regression models were used to evaluate the relative effects of surgeon and hospital volumes on mortality and complications, after adjusting for case mix differences. Results There were 2453 pancreatic resections performed by 490 surgeons operating in 138 hospitals. Of the total, 4.5{\%} of surgeons and 6.5{\%} of hospitals were high volume. The overall 30-d mortality was 9.0{\%}, and the 30-d complication rate was 40.6{\%}. Overall, 8.9{\%} of the variance in 30-d mortality was attributed to surgeon factors and 9.8{\%} to hospital factors. For 30-d complications, 4.7{\%} of the variance was attributed to surgeon factors and 1.2{\%} to hospital factors. After adjusting for patient, surgeon, and hospital characteristics, high surgeon volume (odds ratio [OR] = 0.54, 95{\%} confidence interval [CI], 0.33-0.87) and high hospital volume (OR = 0.52; 95{\%} CI, 0.30-0.92) were associated with lower risk of mortality; high surgeon volume (OR = 0.71, 95{\%} CI, 0.55-0.93) was also associated lower risk of 30-d complications. Conclusions Both hospital and surgeon factors contributed significantly to the observed variance in mortality, but only surgeon factors impacted complications.",
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AU - Parmar, Abhishek D.

AU - Adhikari, Deepak

AU - Tamirisa, Nina P.

AU - Dimou, Francesca

AU - Jupiter, Daniel

AU - Riall, Taylor S.

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AB - Background Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients. Materials and methods The study used Texas Medicare data (2000-2012), identifying high-volume surgeons as those performing ≥4 pancreatic resections/year, and high-volume hospitals as those performing ≥11 pancreatic resections/year, on Medicare patients. Three-level hierarchical logistic regression models were used to evaluate the relative effects of surgeon and hospital volumes on mortality and complications, after adjusting for case mix differences. Results There were 2453 pancreatic resections performed by 490 surgeons operating in 138 hospitals. Of the total, 4.5% of surgeons and 6.5% of hospitals were high volume. The overall 30-d mortality was 9.0%, and the 30-d complication rate was 40.6%. Overall, 8.9% of the variance in 30-d mortality was attributed to surgeon factors and 9.8% to hospital factors. For 30-d complications, 4.7% of the variance was attributed to surgeon factors and 1.2% to hospital factors. After adjusting for patient, surgeon, and hospital characteristics, high surgeon volume (odds ratio [OR] = 0.54, 95% confidence interval [CI], 0.33-0.87) and high hospital volume (OR = 0.52; 95% CI, 0.30-0.92) were associated with lower risk of mortality; high surgeon volume (OR = 0.71, 95% CI, 0.55-0.93) was also associated lower risk of 30-d complications. Conclusions Both hospital and surgeon factors contributed significantly to the observed variance in mortality, but only surgeon factors impacted complications.

KW - Complications

KW - Hospital volume

KW - Mortality

KW - Multilevel models

KW - Pancreatic resection

KW - Surgeon volume

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