The Impact of Interhospital Competition on Treatment Strategy and Outcomes for Unruptured Intracranial Aneurysms
| Autor: | Oliver Y. Tang, James S Yoon, Michael T. Lawton, Wesley M Durand, Shaan A Ahmed |
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| Rok vydání: | 2021 |
| Předmět: |
Clipping (audio)
medicine.medical_specialty Inpatient mortality business.industry Endovascular Procedures Intracranial Aneurysm Odds ratio Length of Stay medicine.disease Embolization Therapeutic Neurosurgical Procedures Odds Competition (economics) Treatment Outcome Aneurysm Emergency medicine Humans Medicine Treatment strategy Surgery Neurology (clinical) Neurosurgery Hospital Costs business |
| Zdroj: | Neurosurgery. 89:695-703 |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1093/neuros/nyab258 |
| Popis: | BACKGROUND Interhospital competition has been shown to affect surgical outcomes and expenditures. However, interhospital competition's impact on neurosurgery is poorly characterized. OBJECTIVE To assess how interhospital competition is associated with treatment strategy and outcomes for unruptured intracranial aneurysms (UIAs). METHODS We identified all elective UIA admissions in the National Inpatient Sample from 2002 to 2011. Competitive intensity of each hospital market was quantified using the validated Herfindahl-Hirschman Index (HHI), with lower values denoting higher competition. We then obtained nationwide HHI values for 2012 to 2016 from the Health Care Cost Project. Outcomes included treatment modality (clipping, coiling, or nonoperative management), inpatient mortality, disposition, complications, length of stay (LOS), and costs. Multivariate regression assessed the association between HHI and outcomes, controlling for patient demographics, severity metrics, hospital characteristics, and treatment. RESULTS We studied 157 979 elective UIA admissions at 1435 hospitals from 2002 to 2011, with an increase in coiling admissions (13.4% to 33.7%) and decrease in clipping admissions (30.9% to 17.6%). Mean hospital HHI was 0.11 (range = 0.001-0.97). Competition decreased for 61.8% of hospitals from 2002 to 2011 and 68.1% of metropolitan localities from 2012 to 2016. Admissions in more competitive hospital markets exhibited increased odds of undergoing surgery (odds ratio [OR] = 1.37, P |
| Databáze: | OpenAIRE |
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