The Volume-Outcome Relationship: is it the same in different procedures?

Presenter: Chentong Hsu, NTU

Abstract

CONTEXT: The relationship between surgeon volume or hospital volume and patient outcomes has been reported in some specific procedures for nearly three decades. However, whether it is applicable to many disparate procedures is still controversial.

PURPOSE: The purpose of this nationwide study was to examine whether the volume-outcome relationship for hospitals and surgeons was similar in different complicated procedures in Taiwan.

METHOD: Four medical procedures were used for analysis in this study: coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), total hip replacement (THR) and appendectomy. Of which included two rather difficult and two relatively common procedures. NHI Research Databases Claim data in year of 2006 was used to evaluate the relationship of the volume and outcome in each procedure. For outcome indicators, we used in-hospital mortality as the outcome variable in CABG and PTCA, whereas 30-day readmission rate as the outcome variable in THR and appendectomy. Furthermore, we used random effect models to investigate the association of volume on outcome variables, taking into account of clustering of patients with particular surgeons within particular hospitals and incorporating the 2 levels of nesting.

RESULT: The preliminary result appeared that the volume-outcome relationship is more significant in the procedures of CABG and PTCA than that in THR and appendectomy. More comprehensive data for the relationship will be further analyzed and more detailed results will be presented in the conference.