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The Impact of Hospital Surgical Volume on Healthcare Utilization Outcomes After Pediatric Thyroidectomy

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Abstract

Background

A positive relationship between an individual surgeon’s operative volume and clinical outcomes after pediatric and adult thyroidectomy is well-established. The impact of a hospital’s pediatric operative volume on surgical outcomes and healthcare utilization, however, are infrequently reported. We investigated associations between hospital volume and healthcare utilization outcomes following pediatric thyroidectomy in Canada’s largest province, Ontario.

Methods

Retrospective analysis of administrative and health-related population-level data from 1993 to 2017. A cohort of 1908 pediatric (<18 years) index thyroidectomies was established. Hospital volume was defined per-case as thyroidectomies performed in the preceding year. Healthcare utilization outcomes: length of stay (LOS), same day surgery (SDS), readmission, and emergency department (ED) visits were measured. Multivariate analysis adjusted for patient-level, disease and hospital-level co-variates.

Results

Hospitals with the lowest volume of pediatric thyroidectomies, accounted for 30% of thyroidectomies province-wide and performed 0–1 thyroidectomies/year. The highest-volume hospitals performed 19–60 cases/year. LOS was 0.64 days longer in the highest, versus the lowest quartile. SDS was 83% less likely at the highest, versus the lowest quartile. Hospital volume was not associated with rate of readmission or ED visits. Increased ED visits were, however, associated with male sex, increased material deprivation, and rurality.

Conclusions

Increased hospital pediatric surgical volume was associated with increased LOS and lower likelihood of SDS. This may reflect patient complexity at such centers. In this cohort, low-volume hospitals were not associated with poorer healthcare utilization outcomes. Further study of groups disproportionately accessing the ED post-operatively may help direct resources to these populations.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by: Canadian Institute for Health Information (CIHI); Immigration, Refugee and Citizenship Canada Permanent Resident Database (IRCC), Ontario Health (OH), Ontario Registrar General (ORG). The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Parts or whole of this material are based on data and/or information compiled and provided by IRCC current to May 2017. However, the analyses, conclusions, opinions, and statements expressed in the material are those of the author(s), and not necessarily those of IRCC. Parts of this material are based on data and information provided by OH. The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of OH. No endorsement by OH is intended or should be inferred. Parts of this report are based on ORG information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the author and do not necessarily reflect those of ORG or the Ministry of Government and Consumer Services. We thank the Toronto Community Health Profiles Partnership for providing access to the Ontario Marginalization Index.

Funding

Dr. AD Chesover was funded by the Canadian Paediatric Endocrine Group. This work was supported by the Pitbaldo Basic/Translational Discovery Grant from the Garron Family Cancer Centre, The Hospital for Sick Children, Toronto (JDW, NEW). This work was also supported through a Harry Barberian Research Grant from the University of Toronto Department of Otolaryngology—Head and Neck Surgery (NEW).

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Authors and Affiliations

  1. Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Alexander D. Chesover & Jonathan D. Wasserman

  2. Department of Otolaryngology—Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, M1-102, Toronto, ON, M4N 3M5, Canada

    Antoine Eskander

  3. ICES Queen’s, Abramsky Hall, Room 208, 21 Arch Street, Kingston, ON, K7L 3N6, Canada

    Antoine Eskander, Rebecca Griffiths & Jason D. Pole

  4. Institute of Health Policy, Management and Evaluation (IHPME), Toronto, ON, Canada

    Antoine Eskander

  5. Division of General Surgery, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C1, Canada

    Jesse D. Pasternak

  6. Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital campus, Brisbane, QLD, 4102, Australia

    Jason D. Pole

  7. Department of Otolaryngology—Head and Neck Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Nikolaus E. Wolter

  8. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Alexander D. Chesover & Jonathan D. Wasserman

  9. Michael Garron Hospital, University of Toronto, Toronto, ON, Canada

    Antoine Eskander

  10. Department of Endocrinology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK

    Alexander D. Chesover

Authors
  1. Alexander D. Chesover
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  2. Antoine Eskander
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  3. Rebecca Griffiths
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  4. Jesse D. Pasternak
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  6. Nikolaus E. Wolter
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  7. Jonathan D. Wasserman
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Corresponding author

Correspondence to Jonathan D. Wasserman.

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Conflict of interest

Dr. A Eskander has received research funds from Merck (2019) and has been a paid consultant for Bristol-Myers (2019) both of which were for work not related to this study. Dr. JD Wasserman was a paid consultant for Bayer (2019) for work unrelated to the study. The remaining authors have no conflicts of interest.

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Chesover, A.D., Eskander, A., Griffiths, R. et al. The Impact of Hospital Surgical Volume on Healthcare Utilization Outcomes After Pediatric Thyroidectomy. World J Surg 46, 1082–1092 (2022). https://doi.org/10.1007/s00268-022-06456-6

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  • DOI: https://doi.org/10.1007/s00268-022-06456-6

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