Is the current referral trend a threat to the Military Health System? Perioperative outcomes and costs after colorectal surgery in the Military Health System versus civilian facilities
| Autor: | David F. Friedlander, Adam C. Fields, Maya Marchese, Junaid Nabi, Nicollette K. Kwon, Peter Herzog, Quoc-Dien Trinh, Eugene B. Cone, Jolene Wun, Austin Haag |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Referral Adolescent Military Health Services MEDLINE 030230 surgery Patient Readmission Odds 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans Referral and Consultation Colectomy Digestive System Surgical Procedures Retrospective Studies Proctectomy business.industry Medical record Perioperative Odds ratio Length of Stay Middle Aged Confidence interval Colorectal surgery United States Intestinal Diseases Treatment Outcome 030220 oncology & carcinogenesis Emergency medicine Surgery business |
| Zdroj: | Surgery. 170(1) |
| ISSN: | 1532-7361 |
| Popis: | Background TRICARE military beneficiaries are increasingly referred for major surgeries to civilian hospitals under “purchased care.” This loss of volume may have a negative impact on the readiness of surgeons working in the “direct-care” setting at military treatment facilities and has important implications under the volume-quality paradigm. The objective of this study is to assess the impact of care source (direct versus purchased) and surgical volume on perioperative outcomes and costs of colorectal surgeries. Methods We examined TRICARE claims and medical records for 18- to 64-year-old patients undergoing major colorectal surgery from 2006 to 2015. We used a retrospective, weighted estimating equations analysis to assess differences in 30-day outcomes (mortality, readmissions, and major or minor complications) and costs (index and total including 30-day postsurgery) for colorectal surgery patients between purchased and direct care. Results We included 20,317 patients, with 24.8% undergoing direct-care surgery. Mean length of stay was 7.6 vs 7.7 days for direct and purchased care, respectively (P = .24). Adjusted 30-day odds between care settings revealed that although hospital readmissions (odds ratio 1.40) were significantly higher in direct care, overall complications (odds ratio 1.05) were similar between the 2 settings. However, mean total costs between direct and purchased care differed ($55,833 vs $30,513, respectively). Within direct care, mean total costs ($50,341; 95% confidence interval $41,509–$59,173) were lower at very high-volume facilities compared to other facilities ($54,869; 95% confidence interval $47,822–$61,916). Conclusion Direct care was associated with higher odds of readmissions, similar overall complications, and higher costs. Contrary to common assumptions regarding volume and quality, higher volume in the direct-care setting was not associated with fewer complications. |
| Databáze: | OpenAIRE |
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