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- Title
The impact of hospital volume on clinical and economic outcomes in ventral hernia repair: an analysis with national policy implications.
- Authors
Chattha, A.; Muste, J.; Patel, A.
- Abstract
<bold>Purpose: </bold>The objectives of this study are to evaluate the associations between ventral hernia repair procedure volume and patient outcomes, including both clinical and economic outcomes.<bold>Method: </bold>The 2014 National Inpatient Sample was queried for patients who underwent elective, open ventral (incisional) hernia repair with or without mesh. Outcomes included occurrence of major or wound-based in-hospital complications, extended length of stay (> 4 days), and increased costs (> $12,816). High-volume hospitals were defined as the 90th percentile of case volume or higher (> 60 cases/year). Multivariate regression was performed to access the outcomes associated with high-volume hospitals.<bold>Results: </bold>54,075 patients at 2049 hospitals were retrieved. 41.4 percent of patients were treated at high-volume hospitals. Patients treated at high-volume hospitals were less likely to experience a major complication (OR 0.88; 95% CI 0.82-0.96; p = 0.002) or wound-based complication (OR 0.84; 95% CI 0.76-0.92; p < 0.001). However, in terms of resource utilization, patients treated at high-volume hospitals were more likely to experience an extended length of stay (OR 1.14; 95% CI 1.09-1.12; p < 0.001) and an increase in costs (OR 1.23; 95% CI 1.17-1.29; p < 0.001).<bold>Conclusion: </bold>Hospitals that perform a larger number of ventral hernia repairs, despite caring for a more complex patient population, may be associated with better patient outcomes than lower volume hospitals. However, these same high-volume centers demonstrate an extended length of stay and increased costs. Further research is needed to understand the reason for this gap in proper resource utilization in high-volume ventral hernia repair centers.
- Subjects
UNITED States; VENTRAL hernia; COST; NATIONAL Policy Forum; ABDOMINAL surgery; HERNIA surgery; MEDICAL care cost statistics; HERNIA; LENGTH of stay in hospitals; HOSPITALS; SURGICAL complications; SURVEYS
- Publication
Hernia, 2018, Vol 22, Issue 5, p793
- ISSN
1265-4906
- Publication type
journal article
- DOI
10.1007/s10029-018-1803-3