Relation of Surgical Volume to Outcome in Eight Common Operations : Results From the VA National Surgical Quality Improvement Program
| Autor: | John G. Demakis, Shukri F. Khuri, Peter J. Fabri, James Gibbs, Jennifer Daley, Frederick L. Grover, David I. Soybel, Kenneth W. Kizer, Lloyd Phillips, Richard H. Bell, Karl E. Hammermeister, J. Bradley Aust, Gerald O. McDonald, John F. Stremple, Frank Scamman, William G. Henderson, Edward Passaro, Monir Hossain, Vernon Chong, Jeannette Spencer, Kwan Hur |
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| Jazyk: | angličtina |
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male Program evaluation medicine.medical_specialty Adolescent Hospitals Veterans MEDLINE Process improvement Outcome (game theory) Health care Outcome Assessment Health Care medicine Humans Letters to the Editor health care economics and organizations Aged Aged 80 and over Models Statistical Multi-Institutional Systems business.industry Public health Scientific Papers of the American Surgical Association Middle Aged Veterans health United States Surgery Acs nsqip United States Department of Veterans Affairs Treatment Outcome Surgical Procedures Operative Emergency medicine Female business Surgery Department Hospital Total Quality Management Program Evaluation |
| Popis: | To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity.In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial.The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA).Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found.In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care. |
| Databáze: | OpenAIRE |
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