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Interaction of Surgeon Volume and Nurse-to-Patient Ratio on Post-operative Outcomes of Medicare Beneficiaries Following Pancreaticoduodenectomy

Journal of Gastrointestinal Surgery volume 24, pages 2551–2559 (2020)Cite this article

Abstract

Background

We sought to assess the effect of nurse-to-patient ratio on outcomes with a focus on defining whether nurse-to-patient ratio altered outcomes relative to pancreaticoduodenectomy (PD) surgeon specific volume.

Methods

Medicare SAFs from 2013–2015 were used to identify patients who underwent PD. Nurse-to-patient ratio, PD specific surgeon volume were stratified. Association of factors associated with short term outcomes was evaluated.

Results

Overall, 6668 patients (median age 73, IQR 68–77; 52.8% male) were identified. The median annual PD volume of surgeons in the highest volume tier was 24 (IQR 21–29), whereas surgeons in the lowest tier performed 2 PDs annually (IQR 1–3) (p < 0.001). Compared with hospitals that had the highest nurse-to-patient ratio tier, patients at hospitals with the lowest nurse-to-patient ratio tier were 26% more likely to have a complication (OR 1.26, 95% CI 1.02–1.55). Additionally, patients of surgeons in the lowest tier had 43% greater odds of suffering a complication compared to patients of surgeons in the highest tier (OR 1.43, 95% CI 1.11–1.84). However, patients who underwent a PD by a surgeon within the lowest tier had similar odds of a complication irrespective of nurse-to-patient ratio (OR 1.34, 95% CI 0.97–1.86).

Conclusion

Compared with patients who underwent an operation by a surgeon in highest PD volume tier, patients treated by surgeons in the lowest tier had higher odds of post-operative complications which was not mitigated by a higher nurse-to-patient ratio.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Anghela Z. Paredes, J. Madison Hyer, Diamantis I. Tsilimigras & Kota Sahara

  2. Division of Health Information Management and Systems, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Susan White

  3. Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA

    Timothy M. Pawlik

Authors
  1. Anghela Z. Paredes
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  2. J. Madison Hyer
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  5. Susan White
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Correspondence to Timothy M. Pawlik.

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Paredes, A.Z., Hyer, J.M., Tsilimigras, D.I. et al. Interaction of Surgeon Volume and Nurse-to-Patient Ratio on Post-operative Outcomes of Medicare Beneficiaries Following Pancreaticoduodenectomy. J Gastrointest Surg 24, 2551–2559 (2020). https://doi.org/10.1007/s11605-019-04449-w

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Keywords

  • Surgeon volume
  • Nurse-to-patient ratio
  • Pancreaticoduodenectomy