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The impact of the institutional abdominoperineal resections volume on short-term outcomes and expenses: a nationwide study

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Abstract

Background

The aim of this study was to evaluate the influence of the institutional volume of abdominoperineal resections (APR) on the short-term outcomes and costs in the Brazilian Public Health system.

Methods

This population-based study evaluated the number of APRs by institutions performed in the Brazilian Public Health system from January/2010 to July/2022. Data were extracted from a public domain from the Brazilian Public Health system.

Results

Four hundred and twelve hospitals performed APRs and were included. Only 23 performed at least 5 APRs per year on average and were considered high-volume institutions. The linear regression model showed that the number of hospital admissions for APRs was negatively associated with in-hospital mortality (Coef. = − 0.001; p = 0.013) and length of stay in the intensive care unit (Coef. = − 0.006; p = 0.01). The number of hospital admissions was not significantly associated with personnel, hospital, and total costs. The in-hospital mortality in high-volume institutions was significantly lower than in low-volume institutions (2.5 vs. 5.9%; p: < 0.001). The mean length of stay in the intensive care unit was shorter in high-volume institutions (1.23 vs. 1.79 days; p = 0.021). In high-volume institutions, the personnel (R$ 952.23 [US$ 186.64] vs. R$ 11,129.04 [US$ 221.29]; p = 0.305), hospital (R$ 4078.39 [US$ 799.36] vs. R$ 4987.39 [US$ 977.53]; p = 0.111), and total costs (R$ 5030.63 [US$ 986.00] vs. R$ 6116.71 [US$ 1198.88]; p = 0.226) were lower.

Conclusions

Higher institutional APR volume is associated with lower in-hospital mortality and less demand for intensive care. The findings of this nationwide study may affect how Public Health manages APR care.

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Funding

The study was not funded.

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Authors and Affiliations

  1. Department of Health Sciences, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Morumbi, São Paulo, SP, 05652-900, Brazil

    Francisco Tustumi, Ana Sarah Portilho, Marcelo Passos Teivelis, Marcelo Fiorelli Alexandrino da Silva, Daniel José Szor, Lucas Soares Gerbasi, Rafael Vaz Pandini, Victor Edmond Seid, Nelson Wolosker & Sérgio Eduardo Alonso Araujo

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  1. Francisco Tustumi
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  2. Ana Sarah Portilho
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  3. Marcelo Passos Teivelis
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  4. Marcelo Fiorelli Alexandrino da Silva
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  6. Lucas Soares Gerbasi
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Correspondence to Francisco Tustumi.

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The local Ethics Committee approved the study, which waived the informed consent forms (SGPP 5338-22). Raw data are publicly available.

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Tustumi, F., Portilho, A.S., Teivelis, M.P. et al. The impact of the institutional abdominoperineal resections volume on short-term outcomes and expenses: a nationwide study. Tech Coloproctol 27, 647–653 (2023). https://doi.org/10.1007/s10151-022-02733-7

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