Adverse outcomes in surgery: redefinition of postoperative complications
Michael Pine and Associates, Chicago, IL 60615, USA. American journal of surgery
(Impact Factor: 2.29).
02/2009; 197(4):479-84. DOI: 10.1016/j.amjsurg.2008.07.056
We propose that excess risk-adjusted, postoperative length of stay (poLOS) is a valid indicator of an adverse outcome.
Hospital administrative claims data for elective colon resection, coronary bypass graft surgery, and total hip replacement were used from the 100 largest-volume hospitals in the Health Care Cost and Utilization Project for 2005. Risk-adjusted poLOS linear models were designed and outliers were determined using control charts. Costs of hospital care were examined by the presence of coded complications (CCs) and/or being a poLOS outlier.
Patterns of CCs and risk-adjusted poLOS outliers were significantly different (P < .0001, chi-square test). For all procedures, costs of care were similar with or without CCs if the patients were not poLOS outliers. For patients who were poLOS outliers, costs were significantly different (Tukey-Kramer test) independent of whether CCs were present or not.
Adverse surgical outcomes are better defined by risk-adjusted poLOS and cost criteria rather than coded or surveillance observations.
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- "We identified confounders on the basis of a literature search, leading to a total of four confounding factors for our propensity score model: age     , sex    , obesity    , and the diagnosis indicating the THR (e.g., coxarthrosis or osteonecrosis) . Since according to previous studies various factors are associated with LOS and hospital costs and an extended LOS has been associated with an increase in resource use    , we used the same propensity scores and consequently the same matched sample for both variables of interest (total costs and LOS). "
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ABSTRACT: A current trend in total hip replacement (THR) is the use of minimally invasive surgery. Little is known, however, about the impact of minimally invasive THR on resource use and length of stay. This study analyzed the effect of minimally invasive surgery on hospital costs and length of stay in German hospitals compared with conventional treatment in THR.
We used patient-level administrative hospital data from three German hospitals participating in the national cost data study. We conducted a propensity score matching to account for baseline differences between minimally invasively and conventionally treated patients. Subsequently, we estimated the treatment effect on costs and length of stay by conducting group comparisons, via paired t tests and Wilcoxon signed-rank tests, and regression analyses.
The three hospitals provided data from 2886 THR patients. The propensity score matching led to 812 matched pairs. Length of stay was significantly higher for conventionally treated patients (11.49 days vs. 10.90 days; P < 0.05), but total costs did not differ significantly (€6018 vs. €5986; P = 0.67). We found a difference in the allocation of costs, with significantly higher implant costs for minimally invasively treated patients (€1514 vs. €1375; P < 0.001) in contrast to significantly higher staff and overhead costs for conventionally treated patients.
Minimally invasive surgery was compared with conventional THR and was found to be associated with a reduced length of stay. Total hospital costs, however, did not differ between the two treatment groups, because of higher implant costs for minimally invasively treated patients.
Value in Health 12/2012; 15(8):999-1004. DOI:10.1016/j.jval.2012.06.008 · 3.28 Impact Factor
Methods in Enzymology 02/2004; 388:269-93. DOI:10.1016/S0076-6879(04)88023-6 · 2.09 Impact Factor
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ABSTRACT: Hybrid procedures combine endovascular and open surgical techniques. We examined utilization rates and ways of performing them more efficiently.
Hybrids were selected using codes for femoral endarterectomy, infrainguinal, or aorto-iliac-femoral bypass and angioplasty from Nationwide Inpatient Sample (NIS) data, then categorized as staged, or performed on the same day. Outcomes included utilization rates, total hospital charges, and length of stay (LOS). Confounders of charges and LOS were identified and excluded from final comparisons.
Utilization increased 7% from 2000 to 2004. Univariate associations linked staging to variables included in linear regressions for hospital charges and LOS. Excluding identified confounders from the final subgroup analysis still showed large differences in charges (same-day = $34,206, staged = $60,087) and LOS (same-day = 3 days, staged = 7 days).
Utilization of hybrids is increasing. Performing hybrids on the same day, if possible, greatly reduces hospital charges and LOS, emphasizing preadmission planning and simultaneous coordination of both portions.
American journal of surgery 12/2008; 196(5):634-40. DOI:10.1016/j.amjsurg.2008.08.003 · 2.29 Impact Factor
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