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Le NK, Chervu NL, Ng A, Gao Z, Cho NY, Charland N, Nesbit SM, Benharash P, Donahue TR. Center-level variation in hospitalization costs of pancreaticoduodenectomy for pancreatic cancer. Surgery 2024; 176:866-872. [PMID: 38971697 DOI: 10.1016/j.surg.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/21/2024] [Accepted: 05/21/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Pancreaticoduodenectomy is a highly morbid operation with significant resource utilization. Using a national cohort, we examined the interhospital variation in pancreaticoduodenectomy hospitalization cost in the United States. METHODS Adults undergoing elective pancreaticoduodenectomy in the setting of pancreatic cancer were tabulated from the 2016-2020 Nationwide Readmissions Database. A 2-level mixed-effects model was developed to evaluate the interhospital variation in pancreaticoduodenectomy hospitalization costs. Institutions within the top decile of risk-adjusted expenditures were defined as high-cost hospitals. Multivariable regression models were fitted to examine the association between high-cost hospital status and outcomes of interest. To account for the effects of complications on expenditures, a subgroup analysis comprising of patients with no adverse events was conducted. RESULTS The study included an estimated 24,779 patients with a median hospitalization cost of $38,800. After mixed-effects modeling, 40.9% of the cost variation was attributable to hospital, rather than patient, factors. Multivariable regression models revealed an association between high-cost hospital status and greater odds of complications and longer length of stay. Among patients without an adverse event, interhospital cost variation remained significant at 61.0%, and treatment at high-cost hospitals was similarly linked to longer length of stay. CONCLUSION Our study identified significant interhospital variation in pancreaticoduodenectomy hospitalization costs in the United States. Although high-cost hospital status was associated with increased odds of complications, variation remained significant even among patients without an adverse event. These results suggest the important role of hospital practices as contributors to expenditures. Further efforts to identify drivers of costs and standardize pancreatic surgical care are warranted.
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Affiliation(s)
- Nguyen K Le
- David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA. https://twitter.com/NguyenKLe18
| | - Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ayesha Ng
- David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Zihan Gao
- David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nam Yong Cho
- David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nicole Charland
- David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shannon M Nesbit
- David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Timothy R Donahue
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Dhimal T, Loria A, Juviler P, Hilty BK, Levatino E, Schiralli MP, Fleming FJ. Quality improvement in surgical collaboratives: Characterizing resources and care variation to facilitate implementation and dissemination. Surgery 2024; 176:214-216. [PMID: 38729886 DOI: 10.1016/j.surg.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Totadri Dhimal
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, NY.
| | - Peter Juviler
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Bailey K Hilty
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Elizabeth Levatino
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | | | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Wasfie T, Sharp A, Chu C, Fox G, Lewis A, Lynch S, Singh S, Wiskur L. Did Implementation of Michigan Surgical Quality Collaborative Initiative Reduce the Post-Operative Infection Rate Elective Colorectal Surgery? A Community Hospital Experience. Am Surg 2024:31348241256061. [PMID: 38770550 DOI: 10.1177/00031348241256061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Tarik Wasfie
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Adriana Sharp
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Cindy Chu
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Griffin Fox
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Anthony Lewis
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Sara Lynch
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Sahiba Singh
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Lori Wiskur
- Department of Infection Control, Ascension Genesys Hospital, Grand Blanc, MI, USA
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Shah TA, Knapp L, Cohen ME, Brethauer SA, Wick EC, Ko CY. Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals. J Am Coll Surg 2023; 236:543-550. [PMID: 36852926 DOI: 10.1097/xcs.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Commonly cited studies have reported substantial improvements (defined as >20%) in process measure compliance after implementation of colorectal enhanced recovery programs (ERPs). However, hospitals have anecdotally reported difficulties in achieving similar improvement gains. This study evaluates improvement uniformity among 151 hospitals exposed to an 18-month implementation protocol for 6 colorectal ERP process measures (oral antibiotics, mechanical bowel preparation, multimodal pain control, early mobilization, early liquid intake, and early solid intake). STUDY DESIGN One hundred fifty-one hospitals implemented a colorectal ERP with pathway, educational and supporting materials, and data capture protocols; 906 opportunities existed for process compliance improvement across the cohort (151 hospitals × 6 process measures). However, 240 opportunities were excluded due to high starting compliance rates (ie compliance >80%) and 3 opportunities were excluded because compliance rates were recorded for fewer than 2 cases. Thus, 663 opportunities for improvement across 151 hospitals were studied. RESULTS Of 663 opportunities, minimal improvement (0% to 20% increase in compliance) occurred in 52% of opportunities, substantial improvement (>20% increase in compliance) in 20%, and worsening compliance occurred in 28%. Of the 6 processes, multimodal pain control and use of oral antibiotics improved the most. CONCLUSIONS Contrary to published ERP literature, the majority of study hospitals had difficulty improving process compliance with 80% of the opportunities not achieving substantial improvement. This discordance between ERP implementation success rates reported in the literature and what is observed in a large sample could reflect differences in hospitals' culture or characteristics, or a publication bias. Attention needs to be directed toward improving ERP adoption across the spectrum of hospital types.
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Affiliation(s)
- Tejen A Shah
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Shah, Brethauer)
| | - Leandra Knapp
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
| | - Mark E Cohen
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
| | - Stacy A Brethauer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Shah, Brethauer)
| | - Elizabeth C Wick
- Department of Surgery, University of California, San Francisco, San Francisco, CA (Wick)
| | - Clifford Y Ko
- From the Division of Research and Optimal Patient Care, American College of Surgeons (Shah, Knapp, Cohen, Ko)
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Ko)
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Huang S, Xie Y, Huang Z, Wu J, Yang J, Tan Q, Chen G, Yuan J, Liu X, Wu H, Liu B, Zhou Y, Li S, Li X, Zhang G, Liu X, Wang J. Preoperative Predictors of Prolonged Hospital Stay in Accelerated Rehabilitation for Patients Undergoing Orthopedic Surgery. Bioinorg Chem Appl 2021; 2021:7832216. [PMID: 34840558 PMCID: PMC8626200 DOI: 10.1155/2021/7832216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 12/27/2022] Open
Abstract
In this study, we performed a retrospective and prospective study of preoperative predictors of the length of stay (LOS) in three groups of surgical patients and conducted a clinical retrospective study of the current research status of preoperative predictors of LOS prolongation in three groups of patients under ERAS (enhanced recovery after surgery) mode, such as patient characteristics and comorbidities. Information such as patients' exercise preferences, exercise time, frequency and duration, footwear, location of knee osteoarthritis, whether there is a past history of knee injury, and smoking and drinking history was collected, and the research data of 312 patients undergoing the three operations were analyzed by SPSS. Meniscal injury-knee arthroscopy sample included a total of 104 people. Surgical sample for anterior cruciate ligament reconstruction included a total of 100 subjects. Knee osteoarthritis-knee replacement surgery sample included 148 people who were divided into two groups in a ratio of 1 : 1: one group used Mailuo Shutong pills during hospitalization (intervention group) and the other group did not (control group). The research conclusions are as follows. Meniscal Knee Arthroscopy. (1) Samples from different causes of injury showed significant differences for all injured sites. (2) Samples with different smoking and drinking histories all showed significant differences for the causes of injury. (3) Exercise hobby, exercise frequency, duration of each exercise and duration of exercise, and warm-up time before exercise all showed positive correlation. Anterior Cruciate Ligament Reconstruction Surgery. (4) Samples from different causes of injury showed significant differences for all the injured sites. (5) Age has a significant negative influence on the wearing of shoes at ordinary times. (6) Exercise hobby: the warm-up time before exercise had a significant negative influence on the injured area. (7) Two groups of analysis items of exercise frequency, exercise duration and exercise duration, preexercise warm-up time, and exercise hobby were typically positively correlated. Total Knee Arthroplasty. (8) There was a significant difference of 0.01 between the hospitalization days of the intervention group and the control group (p < 0.01), and the hospitalization days of the intervention group were significantly lower than those of the control group. These results indicated that Mailuo Shutong pills were of great significance for the treatment of orthopedic patients during the operation period in that it could effectively shorten the hospital stay of all orthopedic patients and strengthen the accelerated rehabilitation. (9) There was a significant positive correlation between the history of knee joint surgery and the use time of Mailuo Shutong pills. (10) There was a markable positive correlation between occupation and sports hobbies, sports time, frequency and duration, and footwear. There was a significant negative correlation between occupation and preexercise warm-up. (11) Exercise time, frequency, and duration have significant positive influence on BMI.
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Affiliation(s)
- Shu Huang
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Yong Xie
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Zhiyan Huang
- Lunan Pharmaceutical Group Co. Ltd., Linyi 276000, China
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi 276000, China
| | - Jiangyi Wu
- Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Junjun Yang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Qiaoyin Tan
- College of Teacher Education, Zhejiang Normal University, Jinhua 321004, China
| | - Guanyu Chen
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Jun Yuan
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Xiaoni Liu
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Hui Wu
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Baorong Liu
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Yizhao Zhou
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Sihong Li
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Xiaosheng Li
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Guimin Zhang
- Lunan Pharmaceutical Group Co. Ltd., Linyi 276000, China
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi 276000, China
| | - Xiangyang Liu
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Jing Wang
- Department of Orthopedics, Hunan Provincial People's Hospital (The First-affiliated Hospital of Hunan Normal University), Changsha 410005, China
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