Nationwide variation in outcomes and cost of laparoscopic procedures
- 523 Downloads
Healthcare systems and surgeons are under increasing pressure to provide high-quality care for the lowest possible cost . This study utilizes national data to examine the outcomes and costs of common laparoscopic procedures based on hospital type and location.
The National Inpatient Sample was queried from 2008 to 2011 for five laparoscopic procedures: colectomy (LC), inguinal hernia repair, ventral hernia repair (LVHR), Nissen fundoplication (NF), and cholecystectomy (LCh). Outcomes, including complication rate and inpatient mortality, were stratified by region and hospital type. Both univariate and multivariate regression analyses were performed using regression-based survey methods; risk-adjusted mean costs for hospital were calculated after adjusting for patient characteristics.
In univariate analysis, the rates of minor complications varied significantly between geographic regions for LCh, LC, NF, and LVHR (p < 0.05). Though LCh and LVHR had statistical variation between regions for rates of major complications (p < 0.05), all regions were equivalent in rates of inpatient mortality for the procedures (p > 0.05). Rural and urban centers had similar rates of complications (p > 0.05), except for higher rates of major complications following IHR and LC in rural centers (p < 0.02) and following Nissen fundoplication in urban facilities(p < 0.0003). Though urban centers were more expensive for all procedures (p < 0.0001), mortality was similar between groups (p > 0.05). For hospital ownership, private investor-owned facilities were substantially more expensive (p < 0.0001), but had no significant differences in complications compared to other hospital types (p > 0.05). In multivariate analysis, while patient factors helped explain differences between outcome differences in different hospital types and locations, in general, the difference in cost remained statistically significant between hospitals.
Though patient demographics and characteristics accounted for some differences in postoperative outcomes after common laparoscopic procedures, higher cost of care was not associated with better outcomes or more complex patients.
KeywordsNational Inpatient Sample (NIS) Hospitals Laparoscopy Cost Regional variation Outcomes
Compliance with Ethical Standards
Drs. Huntington, Cox, Blair, Lincourt, Heniford, and Augenstein and Ms. Prasad declare no personal or financial conflicts of interest relevant to this manuscript or its data.
- 4.The Dartmouth Atlas of Health Care (2014) The Dartmouth Institute. http://www.dartmouthatlas.org/. Accessed Jan 2015
- 5.Sheiner L (2014) Why the geographic variation in health care spending can’t tell us much about the efficiency or quality of our health care system. Paper presented at the fall 2014 brookings panel on economic activity, Washington DCGoogle Scholar
- 6.Interim Report of the Institute of Medicine Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Health Care: Preliminary Committee Observations (2013) The National Academies Press, Washington, DCGoogle Scholar
- 7.Haider DSA (2014) Success in academic surgery: health services research. Springer, New YorkGoogle Scholar
- 10.Ancona C, Agabiti N, Forastiere F, Arca M, Fusco D, Ferro S, Perucci CA (2000) Coronary artery bypass graft surgery: socioeconomic inequalities in access and in 30 day mortality. A population-based study in Rome, Italy. J Epidemiol Community Health 54(12):930–935PubMedCentralCrossRefPubMedGoogle Scholar
- 12.Coakley M (2010) Office of the Massachusetts Attorney General. Investigation of health care cost trends and cost drivers preliminary report. Massachusetts State Government, onlineGoogle Scholar
- 13.Schootman M, Lian M, Pruitt SL, Hendren S, Mutch M, Deshpande AD, Jeffe DB, Davidson NO (2014) Hospital and geographic variability in two colorectal cancer surgery outcomes: complications and mortality after complications. Ann Surg Oncol 21(8):2659–2666. doi: 10.1245/s10434-013-3472-x PubMedCentralCrossRefPubMedGoogle Scholar
- 14.Association BCBS (2015) A study of cost variations for knee and hip replacement surgeries in the U.S. The Health of AmericaGoogle Scholar
- 16.National Health Expenditure Accounts (NHEA) Annual Report (2013). Centers for medicare and medicaid services (CMS), online reportGoogle Scholar
- 18.Get Well Sooner Program. (2015) Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). http://www.sages.org/get-well-sooner/. Accessed Jan 2015
- 22.Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev (10):CD001546. doi: 10.1002/14651858.CD001546.pub3
- 23.Fundamentals of Laparoscopic Surgery (FLS). (2015) Society of American gastrointestinal and endoscopic surgeons. http://www.flsprogram.org. Accessed Jan 2015
- 24.ACGME Resident Case Log System. (2015) Accreditation council for graduate medical education. http://www.acgme.org/. Accessed Jan 2015
- 25.Fox AM, Pitzul K, Bhojani F, Kaplan M, Moulton CA, Wei AC, McGilvray I, Cleary S, Okrainec A (2012) Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center. Surg Endosc 26(5):1220–1230. doi: 10.1007/s00464-011-2061-y CrossRefPubMedGoogle Scholar
- 28.Quality AfHRa (2006–2009) Healthcare cost and utilization project (HCUP) Net: national inpatient sample (NIS). http://hcupnet.ahrq.gov/
- 32.Calculating Nationwide (National) Inpatient Sample (NIS) Variance: Report #2003-02 (2014). HCUP methods series. Agency for healthcare research and quality, Rockville, MDGoogle Scholar
- 34.Hierarchical Modeling using HCUP Data, Report #2007-01 (2007). HCUP methods series. Agency for healthcare research and quality, Rockville, MDGoogle Scholar
- 42.Io Medicine (2003) A shared destiny: community effects of uninsurance. The National Academies Press, Washington, DCGoogle Scholar
- 44.Jepson G (2014) Report of the Connecticut Attorney General Concerning Hospital Physician Practice Acquisitions and Hospital-Based Facility Fees. Office of the Connecticut Attorney General, Connecticut. onlineGoogle Scholar
- 46.Martin Gaynor PhD RTP (2012) Update: the impact of hospital consolidation. the synthesis project. Robert Johnson Wood Foundation, PrincetonGoogle Scholar
- 49.Cheng D, Downey RJ, Kernstine K, Stanbridge R, Shennib H, Wolf R, Ohtsuka T, Schmid R, Waller D, Fernando H, Yim A, Martin J (2007) Video-assisted thoracic surgery in lung cancer resection: a meta-analysis and systematic review of controlled trials. Innovations 2(6):261–292. doi: 10.1097/IMI.0b013e3181662c6a (Philadelphia, Pa) PubMedGoogle Scholar
- 55.Gorgun E, Benlice C, Corrao E, Hammel J, Isik O, Hull T, Remzi FH (2014) Outcomes associated with resident involvement in laparoscopic colorectal surgery suggest a need for earlier and more intensive resident training. Surgery 156(4):825–832. doi: 10.1016/j.surg.2014.06.072 CrossRefPubMedGoogle Scholar
- 57.Unicare (2012) Physician Tiering FAQ. https://www.unicarestateplan.com/pdf/physicianTieringFAQ.pdf. Nov 2014
- 61.Colavita PD, Zemlyak AY, Burton PV, Dacey KT, Walters AL, Lincourt AE, Tsirline VE, Kercher KW, Heniford BT (2013) The expansive cost of wound complications after ventral hernia repair. Presented at the Annual Meeting of the American College of Surgeons, Washington, DCGoogle Scholar