Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Mahmoudi, Elham; Lu, Yiwen; Chang, Shu-Chen; Lin, Chia-Yu; Wang, Yi-Chun; Chang, Chee Jen; Cheng, Ming-Huei; Chung, Kevin C.
• Is Part Of: Plastic and reconstructive surgery. Volume 5:Issue 10(2017)
• Publication Date: 2017-10
• Subjects: Surgery, Plastic -- Periodicals; Surgery, Plastic -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; 617.95205
• DOI: 10.1097/GOX.0000000000001520
• Languages: English
• ISSNs: 2169-7574

Abstract

Abstract : Background: We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS. Methods: Using Taiwan's national data (2001–2012), we conducted a retrospective cohort study of all adults 18–64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day. Results: Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals ( P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11–1.55) and high-volume surgeons (OR = 1.16; CI, 1.03–1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small. Conclusions: There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan. Abstract : Supplemental Digital Content is available in the text.