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The volume–outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching

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Abstract

Background

The volume–outcome relationship has been validated previously for surgical procedures and cancer treatments. However, no studies have longitudinally compared the relationships between volume and outcome, and none have systematically compared laparoscopic cholecystectomy (LC) surgery outcomes in Taiwan. This study purposed to explore the relationship between volume and hospital treatment cost after LC.

Methods

This cohort study retrospectively analyzed 247,751 LCs performed from 1998 to 2009. Hospitals were classified as low-, medium-, and high-volume hospitals if their annual number of LCs were 1–29, 30–84, ≥85, respectively. Surgeons were classified as low-, medium-, and high-volume surgeons if their annual number of LCs were 1–10, 11–24, ≥25, respectively. Hierarchical linear regression model and propensity score were used to assess the relationship between volume and hospital treatment cost.

Results

The mean hospital treatment cost was US $2,504.53, and the average hospital costs for high-volume hospitals/surgeons were 33/47 % lower than those for low-volume hospitals and surgeons. When analyzed by propensity score, the hospital treatment cost differed significantly between high-volume hospitals/surgeons and low/medium-volume hospitals/surgeons (2,073.70 vs. 2,350.91/2,056.73 vs. 2,553.76, P < 0.001).

Conclusions

Analysis using a hierarchical linear regression model and propensity score found an association between high-volume hospitals and surgeons and hospital treatment cost in LC patients. Moreover, the significant factors associated with hospital resource utilization for this procedure include age, gender, comorbidity, hospital type, hospital volume, and surgeon volume. Additionally, analysis of the treatment strategies adopted at high-volume hospitals or by high-volume surgeons may improve overall hospital treatment cost.

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References

  1. Singla A, Simons JP, Carroll JE, Li Y, Ng SC, Tseng JF, Shah SA (2010) Hospital volume as a surrogate for laparoscopically assisted colectomy. Surg Endosc 24:662–669

    Article  PubMed  Google Scholar 

  2. Saad S, Paul A, Treckmann J, Tarabichi A, Nagelschmidt M, Arns W (2010) Laparoscopic live donor nephrectomy: are ten cases per year enough to reach the quality standards? A report from a single small-volume transplant center. Surg Endosc 24:594–600

    Article  PubMed  CAS  Google Scholar 

  3. Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Büsing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252:263–270

    Article  PubMed  Google Scholar 

  4. Shi HY, Lee HH, Tsai MH, Chiu CC, Uen YH, Lee KT (2011) Long-term outcomes of laparoscopic cholecystectomy: a prospective piecewise linear regression analysis. Surg Endosc 25:2132–2140

    Article  PubMed  Google Scholar 

  5. Mercado MÁ, Franssen B, Dominguez I, Arriola-Cabrera JC, Ramírez-Del Val F, Elnecavé-Olaiz A, Arámburo-García R, García A (2011) Transition from a low- to a high-volume centre for bile duct repair: changes in technique and improved outcome. HPB (Oxford) 13:767–773

    Article  Google Scholar 

  6. Csikesz NG, Singla A, Murphy MM, Tseng JF, Shah SA (2010) Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci 55:2398–2405

    Article  PubMed  Google Scholar 

  7. Livingston EH, Cao J (2010) Procedure volume as a predictor of surgical outcomes. JAMA 304:95–97

    Article  PubMed  CAS  Google Scholar 

  8. D’Hoore W, Sicotte C, Tilquin C (1993) Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med 32:382–387

    PubMed  Google Scholar 

  9. Marí-Dell’Olmo M, Martínez-Beneito MA, Borrell C, Zurriaga O, Nolasco A, Domínguez-Berjón MF (2011) Bayesian factor analysis to calculate a deprivation index and its uncertainty. Epidemiology 22:356–364

    Article  PubMed  Google Scholar 

  10. Hobbs BP, Carlin BP, Mandrekar SJ, Sargent DJ (2011) Hierarchical commensurate and power prior models for adaptive incorporation of historical information in clinical trials. Biometrics 67:1047–1056

    Article  PubMed  Google Scholar 

  11. Joffe MM, Rosenbaum PR (1999) Invited commentary: propensity scores. Am J Epidemiol 150:327–333

    Article  PubMed  CAS  Google Scholar 

  12. Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127:757–763

    Article  PubMed  CAS  Google Scholar 

  13. Okrainec A, Ferri LE, Feldman LS, Fried GM (2011) Defining the learning curve in laparoscopic paraesophageal hernia repair: a CUSUM analysis. Surg Endosc 25:1083–1087

    Article  PubMed  Google Scholar 

  14. Kiran RP, Kirat HT, Ozturk E, Geisler DP, Remzi FH (2010) Does the learning curve during laparoscopic colectomy adversely affect costs? Surg Endosc 24:2718–2722

    Article  PubMed  Google Scholar 

  15. Bergamini C, Martellucci J, Tozzi F, Valeri A (2011) Complications in laparoscopic adrenalectomy: the value of experience. Surg Endosc 25:3845–3851

    Article  PubMed  Google Scholar 

  16. Harboe KM, Bardram L (2011) The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc 25:1630–1641

    Article  PubMed  Google Scholar 

  17. Panageas KS, Schrag D, Riedel E, Bach PB, Begg CB (2003) The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med 139:658–665

    Article  PubMed  Google Scholar 

  18. Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D (2011) Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surg Endosc 25:1127–1135

    Article  PubMed  Google Scholar 

  19. Jacobson KM, Hall Long K, McMurtry EK, Naessens JM, Rihal CS (2007) The economic burden of complications during percutaneous coronary intervention. Qual Saf Health Care 16:154–159

    Article  PubMed  Google Scholar 

  20. Lai CL, Fan CM, Liao PC, Tsai KC, Yang CY, Chu SH, Chien KL (2009) Impact of an audit program and other factors on door-to-balloon times in acute ST-elevation myocardial infarction patients destined for primary coronary intervention. Acad Emerg Med 16:333–342

    Article  PubMed  Google Scholar 

  21. Wang MJ, Lin SP (2010) Study on doctor shopping behavior: insight from patients with upper respiratory tract infection in Taiwan. Health Policy 94:61–67

    Article  PubMed  Google Scholar 

  22. Cheng SH, Song HY (2004) Physician performance information and consumer choice: a survey of subjects with the freedom to choose between doctors. Qual Saf Health Care 13:98–101

    Article  PubMed  Google Scholar 

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Disclosures

Hon-Yi Shi, King-Teh Lee, Chong-Chi Chiu, and Hao-Hsien Lee have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hon-Yi Shi & King-Teh Lee

  2. Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    King-Teh Lee

  3. Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

    Chong-Chi Chiu

  4. Taipei Medical University, Taipei, Taiwan

    Chong-Chi Chiu

  5. Chia Nan University of Pharmacy and Science, Tainan, Taiwan

    Chong-Chi Chiu

  6. Department of Surgery, Chi Mei Medical Center, 100-Shih-Chun 1st Road, Liouying, Tainan, 80708, Taiwan

    Hao-Hsien Lee

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  1. Hon-Yi Shi
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  2. King-Teh Lee
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  4. Hao-Hsien Lee
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Correspondence to Hao-Hsien Lee.

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Shi, HY., Lee, KT., Chiu, CC. et al. The volume–outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching. Surg Endosc 27, 3139–3145 (2013). https://doi.org/10.1007/s00464-013-2867-x

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  • DOI: https://doi.org/10.1007/s00464-013-2867-x

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