The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy
<i>Background and Objectives</i>: Previous studies have demonstrated superior patient outcomes for thoracic oncology patients treated at high-volume surgery centers compared to low-volume centers. However, the specific role of overall hospital size in open esophagectomy morbidity and mor...
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doaj-9f15eef523834daa845d94ddeb70b93e2020-11-24T21:37:00ZengMDPI AGMedicina1010-660X2019-10-01551066910.3390/medicina55100669medicina55100669The Impact of Hospital Size on National Trends and Outcomes Following Open EsophagectomySameer A. Hirji0Rohan M. Shah1Adam Fields2Vwaire Orhurhu3Nizar Bhulani4Abby White5Gita N. Mody6Scott J. Swanson7Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USAT. H. Chan Harvard School of Public Health, Boston, MA 02115, USAT. H. Chan Harvard School of Public Health, Boston, MA 02115, USAT. H. Chan Harvard School of Public Health, Boston, MA 02115, USADivision of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USADivision of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC 27599-7065, USADivision of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA<i>Background and Objectives</i>: Previous studies have demonstrated superior patient outcomes for thoracic oncology patients treated at high-volume surgery centers compared to low-volume centers. However, the specific role of overall hospital size in open esophagectomy morbidity and mortality remains unclear. <i>Materials and Methods:</i> Patients aged >18 years who underwent open esophagectomy for primary malignant neoplasia of the esophagus between 2002 and 2014 were identified using the National Inpatient Sample. Minimally invasive procedures were excluded. Discharges were stratified by hospital size (large, medium, and small) and analyzed using trend and multivariable regression analyses. <i>Results</i>: Over a 13-year period, a total of 69,840 open esophagectomy procedures were performed nationally. While the proportion of total esophagectomies performed did not vary by hospital size, in-hospital mortality trends decreased for all hospitals (large (7.2% to 3.7%), medium (12.8% vs. 4.9%), and small (12.8% vs. 4.9%)), although this was only significant for large hospitals (<i>P</i> < 0.01). After controlling for patient demographics, comorbidities, admission, and hospital-level factors, hospital length of stay (LOS), total inflation-adjusted costs, in-hospital mortality, and complications (cardiac, respiratory, vascular, and bleeding) did not vary by hospital size (all <i>P</i> > 0.05). <i>Conclusions</i>: After risk adjustment, patient morbidity and in-hospital mortality appear to be comparable across all institutions, including small hospitals. While there appears to be an increased push for referring patients to large hospitals, our findings suggest that there may be other factors (such as surgeon type, hospital volume, or board status) that are more likely to impact the results; these need to be further explored in the current era of episode-based care.https://www.mdpi.com/1010-660X/55/10/669open esophagectomyhospital sizeesophageal cancer |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sameer A. Hirji Rohan M. Shah Adam Fields Vwaire Orhurhu Nizar Bhulani Abby White Gita N. Mody Scott J. Swanson |
spellingShingle |
Sameer A. Hirji Rohan M. Shah Adam Fields Vwaire Orhurhu Nizar Bhulani Abby White Gita N. Mody Scott J. Swanson The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy Medicina open esophagectomy hospital size esophageal cancer |
author_facet |
Sameer A. Hirji Rohan M. Shah Adam Fields Vwaire Orhurhu Nizar Bhulani Abby White Gita N. Mody Scott J. Swanson |
author_sort |
Sameer A. Hirji |
title |
The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy |
title_short |
The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy |
title_full |
The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy |
title_fullStr |
The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy |
title_full_unstemmed |
The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy |
title_sort |
impact of hospital size on national trends and outcomes following open esophagectomy |
publisher |
MDPI AG |
series |
Medicina |
issn |
1010-660X |
publishDate |
2019-10-01 |
description |
<i>Background and Objectives</i>: Previous studies have demonstrated superior patient outcomes for thoracic oncology patients treated at high-volume surgery centers compared to low-volume centers. However, the specific role of overall hospital size in open esophagectomy morbidity and mortality remains unclear. <i>Materials and Methods:</i> Patients aged >18 years who underwent open esophagectomy for primary malignant neoplasia of the esophagus between 2002 and 2014 were identified using the National Inpatient Sample. Minimally invasive procedures were excluded. Discharges were stratified by hospital size (large, medium, and small) and analyzed using trend and multivariable regression analyses. <i>Results</i>: Over a 13-year period, a total of 69,840 open esophagectomy procedures were performed nationally. While the proportion of total esophagectomies performed did not vary by hospital size, in-hospital mortality trends decreased for all hospitals (large (7.2% to 3.7%), medium (12.8% vs. 4.9%), and small (12.8% vs. 4.9%)), although this was only significant for large hospitals (<i>P</i> < 0.01). After controlling for patient demographics, comorbidities, admission, and hospital-level factors, hospital length of stay (LOS), total inflation-adjusted costs, in-hospital mortality, and complications (cardiac, respiratory, vascular, and bleeding) did not vary by hospital size (all <i>P</i> > 0.05). <i>Conclusions</i>: After risk adjustment, patient morbidity and in-hospital mortality appear to be comparable across all institutions, including small hospitals. While there appears to be an increased push for referring patients to large hospitals, our findings suggest that there may be other factors (such as surgeon type, hospital volume, or board status) that are more likely to impact the results; these need to be further explored in the current era of episode-based care. |
topic |
open esophagectomy hospital size esophageal cancer |
url |
https://www.mdpi.com/1010-660X/55/10/669 |
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