Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers

2022 ◽  
Author(s):  
Martin Lacher ◽  
Winfried Barthlen ◽  
Felicitas Eckoldt ◽  
Guido Fitze ◽  
Jörg Fuchs ◽  
...  
Keyword(s):  
Congenital Malformations ◽  
Surgical Care ◽  
High Volume ◽  
Anorectal Malformations ◽  
Posterior Urethral Valves ◽  
Insurance Companies ◽  
University Hospitals ◽  
Disease Category ◽  
Abdominal Emergencies ◽  
Low Volume

Abstract Introduction Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years. Methods Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into “high,” “medium,” and “low” volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period. Results From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18–258). Four institutions (21%) were classified as “high volume” centers, four (21%) as “medium volume” centers, and 11 (58%) as “low volume” centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%. Conclusion This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.

scholarly journals Accessing surgical care for esophageal cancer: patient travel patterns to reach higher volume center

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Adrian Diaz ◽  
Sarah Burns ◽  
Desmond D’Souza ◽  
Peter Kneuertz ◽  
Robert Merritt ◽  
...  
Keyword(s):  
Health Planning ◽  
Surgical Care ◽  
High Volume ◽  
Travel Patterns ◽  
Care Access ◽  
Patient Travel ◽  
High Volume Hospital ◽  
High Volume Center ◽  
Low Volume ◽  
Esophagectomy For Cancer

SUMMARY While better outcomes at high-volume surgical centers have driven the regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate the travel patterns among patients undergoing esophagectomy to assess willingness of patients to travel for surgical care. The California Office of Statewide Health Planning database was used to identify patients who underwent esophagectomy between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed esophagectomy to get to a higher volume center, was assessed. Overall 3,269 individuals underwent an esophagectomy for cancer in 154 hospitals; only five hospitals were high volume according to Leapfrog standards. Median travel time to a hospital that performed esophagectomy was 26 minutes (IQR: 13.1–50.7). The overwhelming majority of patients (85%) bypassed the nearest providing hospital to seek care at a destination hospital. Among patients who bypassed a closer hospital, only 36% went to a high-volume hospital. Of the 2,248 patients who underwent esophagectomy at a low-volume center, 1,491 patients had bypassed a high-volume hospital. Of the remaining 757 patients who did not bypass a high-volume hospital, half of the individuals would have needed to travel less than an additional hour to reach a high-volume center. Nearly two-thirds of patients undergoing an esophagectomy for cancer received care at a low-volume center; 85% of patients either bypassed a high-volume hospital or would have needed to travel less than an additional hour to reach a high-volume center.

scholarly journals Volume-Based Care among Young Women Diagnosed with Uterine Cancer

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Young Women ◽  
Regression Models ◽  
Uterine Cancer ◽  
Surgical Care ◽  
High Volume ◽  
Service Cost ◽  
Health Service Cost ◽  
Logistic Regression Models ◽  
Adjusted Cost ◽  
Low Volume

Purpose. To characterize volume-based care of uterine cancer among women aged ≤50 years. Methods. The Maryland Health Service Cost Review Commission database was accessed for uterine cancer surgical cases from 1994 to 2005. Cross-tabulations and logistic regression models were used to evaluate for significant associations among volume-based care and other variables comparing women ≤50 years with those aged >50 years. Results. Women ≤50 years comprised 13.6% of the cases. Women ≤50 years were less likely to be managed by high-volume surgeons (31.6% versus 35.1%, ). For women ≤50 years, there was a trend toward management at low-volume hospitals (52.0% versus 54.0%, ). No deaths were reported among the group of women ≤50 years treated by high-volume providers or at high-volume centers. Women ≤50 years managed by high-volume surgeons had longer length of stay () and higher adjusted cost of hospital-related care (). Women ≤50 years managed at high-volume centers had higher adjusted cost of hospital-related care (). Conclusion. Primary surgical care of young women with uterine cancer is often performed by low-volume providers.

scholarly journals Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care

Surgery ◽  
2016 ◽  
Vol 160 (4) ◽  
pp. 839-849 ◽  
Author(s):  
Anai N. Kothari ◽  
Barbara A. Blanco ◽  
Sarah A. Brownlee ◽  
Ann E. Evans ◽  
Victor A. Chang ◽  
...  
Keyword(s):  
Surgical Care ◽  
High Volume ◽  
High Quality ◽  
Cancer Resection ◽  
Low Volume

High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a “Field Effect” for Pancreaticoduodenectomy?

2016 ◽  
Vol 82 (5) ◽  
pp. 407-411 ◽  
Author(s):  
Thomas W. Wood ◽  
Sharona B. Ross ◽  
Ty A. Bowman ◽  
Amanda Smart ◽  
Carrie E. Ryan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Field Effect ◽  
Hospital Volume ◽  
Patient Discharge ◽  
High Volume ◽  
Surgeon Volume ◽  
Hospital Charges ◽  
Leapfrog Group ◽  
Discharge Status ◽  
Low Volume

Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 “high-volume” surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 “low-volume” surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital “field effect.”

scholarly journals Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Josephine Obel ◽  
Antonio Isidro Carrion Martin ◽  
Abdul Wasay Mullahzada ◽  
Ronald Kremer ◽  
Nanna Maaløe
Keyword(s):  
Quality Of Care ◽  
Birth Outcomes ◽  
Birth Outcome ◽  
High Volume ◽  
Maternal Health Service ◽  
Service Access ◽  
Intrapartum Care ◽  
Health Service Access ◽  
Low Volume

Abstract Background Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes. Methods A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Results Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Conclusions Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

scholarly journals Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery

2021 ◽  
Author(s):  
Miriam Lillo-Felipe ◽  
Rebecka Ahl Hulme ◽  
Maximilian Peter Forssten ◽  
Gary A. Bass ◽  
Yang Cao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
High Volume ◽  
Cancer Surgery ◽  
Colon And Rectal Surgery ◽  
Surgical Volume ◽  
Failure To Rescue ◽  
Colorectal Cancer Surgery ◽  
Procedure Volume ◽  
Low Volume

Abstract Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

scholarly journals Colorectal cancer screening behaviors of general surgeons and first-degree family members: a survey-based study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Suleyman Utku Celik ◽  
Hasan Gorkem Cay ◽  
Ersin Bayrakdar ◽  
Aysima Ince ◽  
Esra Nur Ince ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Family Members ◽  
High Volume ◽  
Routine Screening ◽  
Care Providers ◽  
Crc Screening ◽  
First Degree Relatives ◽  
General Surgeons ◽  
Low Volume ◽  
Screening Behaviors

Abstract Background Colorectal cancer (CRC) screening rates are low in the general population and among health care providers. The aim of this study was to evaluate the CRC screening practices of general surgeons who provide specialized diagnostic testing and CRC treatment and to examine the CRC screening behaviors of their first-degree family members. Methods A cross-sectional survey was conducted among general surgeons who attended the 21st National Surgical Congress in Turkey held from April 11th to 15th, 2018. The survey included items on demographics, screening-related attitude, CRC screening options, barriers to CRC screening, and surgeons’ annual volumes of CRC cases. Results A total of 530 respondents completed the survey. Almost one-third of the responding surgeons (29.4%, n = 156) were aged over 50 years, among whom approximately half (47.1%, n = 74) reported having undergone CRC screening and preferring a colonoscopy as the screening modality (78.4%). Among general surgeons aged 50 years and older, high-volume surgeons (≥25 CRC cases per year) were more likely to undergo screening compared with low-volume surgeons (< 25 CRC cases per year). The respondents aged below 50 years reported that 56.1% (n = 210) of their first-degree relatives were up-to-date with CRC screening, mostly with colonoscopy. Compared to low-volume surgeons aged below 50 years, high-volume surgeons’ first-degree relatives were more likely to be up-to-date with CRC screening. Conclusion The survey results demonstrated that routine screening for CRC among surgeons and/or their first-degree relatives is currently not performed at the desired level. However, high-volume surgeons are more likely to participate in routine screening.

Is high-intensity interval training a time-efficient exercise strategy to improve health and fitness?

2014 ◽  
Vol 39 (3) ◽  
pp. 409-412 ◽  
Author(s):  
Jenna B. Gillen ◽  
Martin J. Gibala
Keyword(s):  
High Intensity ◽  
Disease Risk ◽  
Interval Training ◽  
High Volume ◽  
Oxidative Capacity ◽  
High Intensity Interval Training ◽  
Exercise Participation ◽  
Cardiometabolic Disorders ◽  
Low Volume ◽  
High Intensity Interval

Growing research suggests that high-intensity interval training (HIIT) is a time-efficient exercise strategy to improve cardiorespiratory and metabolic health. “All out” HIIT models such as Wingate-type exercise are particularly effective, but this type of training may not be safe, tolerable or practical for many individuals. Recent studies, however, have revealed the potential for other models of HIIT, which may be more feasible but are still time-efficient, to stimulate adaptations similar to more demanding low-volume HIIT models and high-volume endurance-type training. As little as 3 HIIT sessions per week, involving ≤10 min of intense exercise within a time commitment of ≤30 min per session, including warm-up, recovery between intervals and cool down, has been shown to improve aerobic capacity, skeletal muscle oxidative capacity, exercise tolerance and markers of disease risk after only a few weeks in both healthy individuals and people with cardiometabolic disorders. Additional research is warranted, as studies conducted have been relatively short-term, with a limited number of measurements performed on small groups of subjects. However, given that “lack of time” remains one of the most commonly cited barriers to regular exercise participation, low-volume HIIT is a time-efficient exercise strategy that warrants consideration by health practitioners and fitness professionals.

Relationship between hospital surgical volume, lobectomy rates, and adverse perioperative events at US epilepsy centers

2013 ◽  
Vol 118 (1) ◽  
pp. 169-174 ◽  
Author(s):  
Dario J. Englot ◽  
David Ouyang ◽  
Doris D. Wang ◽  
John D. Rolston ◽  
Paul A. Garcia ◽  
...  
Keyword(s):  
Relative Risk ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
High Volume ◽  
Population Based ◽  
Treatment Center ◽  
Surgical Volume ◽  
Related Factors ◽  
Perioperative Morbidity ◽  
Low Volume

Object Epilepsy surgery remains significantly underutilized. The authors recently reported that the number of lobectomies for localized intractable epilepsy in the US has not changed despite the implementation of clear evidence-based guidelines 10 years ago supporting early referral for surgery. To better understand why epilepsy surgery continues to be underused, the authors' objective was to carefully examine hospital-related factors related to the following: 1) where patients are being admitted for the evaluation of epilepsy, 2) rates of utilization for surgery across hospitals, and 3) perioperative morbidity between hospitals with low versus high volumes of epilepsy surgery. Methods The authors performed a population-based cohort study of US hospitals between 1990 and 2008 using the Nationwide Inpatient Sample (NIS), stratifying epilepsy surgery rates and trends as well as perioperative morbidity rates by hospital surgical volume. Results The number of lobectomies for epilepsy performed at high-volume centers (> 15 lobectomies/year) significantly decreased between 1990 and 2008 (F = 20.4, p < 0.001), while significantly more procedures were performed at middle-volume hospitals (5–15 lobectomies/year) over time (F = 16.1, p < 0.001). No time trend was observed for hospitals performing fewer than 5 procedures per year. However, patients admitted to high-volume centers were significantly more likely to receive lobectomy than those at low-volume hospitals (relative risk 1.05, 95% CI 1.03–1.08, p < 0.001). Also, the incidence of perioperative adverse events was significantly higher at low-volume hospitals (12.9%) than at high-volume centers (6.1%) (relative risk 1.08, 95% CI 1.03–1.07, p < 0.001). Conclusions Hospital volume is an important predictor of epilepsy surgery utilization and perioperative morbidity. Patients with medically refractory epilepsy should be referred to a comprehensive epilepsy treatment center for surgical evaluation by an experienced clinical team.

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