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Effect of Hospital Volume on Outcomes of Laparoscopic Appendectomy for Acute Appendicitis: an Observational Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

This study investigated the effect of hospital volume on outcomes of laparoscopic appendectomy for acute appendicitis.

Methods

In total, 30,525 patients who underwent laparoscopic appendectomy for acute appendicitis were referred to 825 hospitals in Japan from 2010 to 2012. We compared appendectomy-related complications, length of stay (LOS), and medical costs in relation to hospital volume. For this study period, hospitals were categorized as low-volume hospitals (LVHs, <50 cases), medium-volume hospitals (MVHs, 50–100 cases), or high-volume hospitals (HVHs, >100 cases).

Results

Significant differences in appendectomy-related complications were observed among the LVHs, MVHs, and HVHs (6.9, 7.2, and 6.0 %, respectively; p = 0.001). Multiple logistic regression revealed that HVHs were associated with a lower relative risk of appendectomy-related complications than were LVHs and MVHs (odds ratio [OR], 0.84; 95 % confidence interval [CI], 0.74–0.95; p = 0.006). Multiple linear regression showed that HVHs were associated with shorter LOS and lower medical costs than were LVHs and MVHs. The unstandardized coefficient for LOS was −0.92 days (95 % CI, −1.07 to −0.78; p < 0.001), whereas that for medical costs was − $167.4 (95 % CI, −256.2 to −78.6; p < 0.001).

Conclusions

Hospital volume was significantly associated with laparoscopic appendectomy outcomes.

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Acknowledgments

This study was funded by Grants-in-Aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan.

Conflict of Interest

None of the authors have any conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan

    Atsuhiko Murata, Keiji Muramatsu, Makoto Ohtani & Shinya Matsuda

  2. Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan

    Toshihiko Mayumi

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  1. Atsuhiko Murata
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  2. Toshihiko Mayumi
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  3. Keiji Muramatsu
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  5. Shinya Matsuda
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Correspondence to Atsuhiko Murata.

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Murata, A., Mayumi, T., Muramatsu, K. et al. Effect of Hospital Volume on Outcomes of Laparoscopic Appendectomy for Acute Appendicitis: an Observational Study. J Gastrointest Surg 19, 897–904 (2015). https://doi.org/10.1007/s11605-015-2746-y

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  • DOI: https://doi.org/10.1007/s11605-015-2746-y

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