Association of Allogeneic Red Blood Cell Transfusion with Surgeon Case Volume
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<0.001). Similar race and gender trends were observed within each age category. Conclusion: The ISS possesses excellent discrimina- tory ability in all populations as indicated by the high ROC’s. The slight differences in its discriminatory capability by ethnicity and gender further emphasize the importance of adjusting for these cova- riates in any analysis. Further studies should be conducted to inves- tigate these ethnic and gender differences. 51.16. The Business Case for the Reduction of Surgical Complications. M. Vaughan-Sarrazin, L. Bayman, G. Rosenthal, J. Cullen; University of Iowa, Iowa City, IA Objectives: Surgical complications contribute significantly to costs. Most importantly, surgical complications contribute to morbidity and mortality and some may be preventable. This study estimates costs of specific surgical complications for patients undergoing gen- eral surgery in VA hospitals using merged data from the VHA Na- tional Surgical Quality Improvement Program (NSQIP) and VA Decision Support System (DSS). Methods: NSQIP provides detailed information on preoperative risk factors and on the occurrence of 19 specific postoperative complications in patients undergoing surgery in all VHA hospitals, while DSS provides detailed cost data of all hos- pitalizations within VHA using state-of-the-art cost accounting methods. Costs associated with 19 potentially preventable complica- tions within six broader categories were estimated using generalized linear mixed regression models to control for patient-level determi- nants of costs (e.g., type of surgery, demographics, comorbidity, sever- ity) and hospital-level variation in costs. Costs included costs of the index hospitalization and subsequent 30 day readmissions. Results: In 15,076 patients undergoing general surgical procedures from 10/ 2005 through 9/2006, 28% of patients developed postoperative surgi- cal complications. The presence of any complication significantly in- creased unadjusted costs nearly 3-fold ($59750 vs. $20,910), with the largest cost differential attributed to respiratory complications (Table). Patients who developed complications had several markers for greater pre-operative severity, including increased age and lower pre-surgery functional health status. After controlling for differences in patient severity, costs for patients with any complication were 1.67 (p<.0001) times greater compared to costs for patients with no compli- cations. Within major complication categories, adjusted costs were 1.95, 1.46, 1.46, 1.67, 1.58, and 1.30 times higher for patients with re- spiratory, cardiac, central nervous system, urinary, wound, or other complications (all P-values < 0.0001). *P < 0.0001 vs. no complication Conclusions: Surgical complications contribute significantly to costs of inpatient surgeries. Investment in quality improvement that reduces surgical complications could decrease costs. 51.17. Economic and Outcome-Based Analysis of Symptom- atic Varicose Vein Treatment. J. L. Eidson, III, M. D. Atkins, Jr, W. T. Bohannon, C. J. Buckley, R. L. Bush; Scott & White Hospital, Texas A & M University College of Medicine, Temple, TX Objective: Endoluminal treatment of symptomatic varicose veins (VV) has been confirmed to reduce inpatient stay and complication rates as well as increase revenue for centers adopting this technique. This study demonstrates the impact of non-parallel cohorts, both in terms of outcomes and economics, on a single center vascular service. Methods: Outpatient radiofrequency ablation (RFA) of symptomatic VV has been performed since May 2007 at our institution. A cohort of 100 RFA patients (26% CEAP class C5/C6) were compared to 100 pa- tients who underwent traditional greater saphenous vein ligation and stripping (GSVL; 18% C5/C6) (August 2002-October 2007). The time frames were chosen to allow at least 6-month follow-up. Patients who had adjunctive removal of secondary varicosities were included in both cohorts. Cost calculations are based on 2007-dollar hospital charges and do not include professional fees. Results: The results are presented in Table 1: Reflux was successfully eliminated in 99% of RFA patients at 6 months. The direct and indirect per patient costs associated with per- forming RFA in an outpatient clinic were $1180.23 vs. $10,101.53 for GSVL in the operating room setting. Conclusions: The establish- ment of a minimally invasive treatment program for VV has rapidly increased volume at our institution in a short period of time due to lack of hospitalization as well as immediate return to work and leisure activity. Furthermore, GSVL was associated with more need for fol- low-up visits and considerably higher costs than endovenous ablation performed in an outpatient treatment room setting. 51.18. Association of Allogeneic Red Blood Cell Transfusion with Surgeon Case Volume. J. C. Pham, E. R. Haut, C. L. Catlett, S. M. Berenholtz; Johns Hopkins University, Baltimore, MD Background: Surgeon case-volume predicts a variety of patient outcomes. We hypothesize that surgeon case-volume predicts RBC transfusion across different surgical procedures. Methods: We performed a cohort study of 372,670 inpatient surgical cases in the 52 non-federal hospitals in Maryland between 2004 and 2005. The main outcome measure was relative risk of receiving a transfusion. Results: Overall, 13.9% of patients received a transfusion. Patients seen by the highest case-volume surgeons (>161 cases/yr) were more likely to receive a transfusion (16% vs 11%, p < 0.01) compared to middle case-volume surgeons (89-161 cases/yr). After adjusting for confounders, the highest case-volume patients were still at increased risk of transfusion (RR 1.10, 1.07-1.14). This result was true across many surgery types. Conclusions: Surgeon case-volume is indepen- dently associated with the likelihood of RBC transfusion across a broad range of surgical procedures. Future efforts should be directed towards studying and standardization of transfusion practices. 51.19. Does Having Insurance Lead to Better Patient Educa- tion? A Study of 533 Patients. Y. Zhuge, C. Schulman, M. C. Cheung, P. Ramos, M. de la Cruz, O. C. Velazquez; University of Miami Miller School of Medicine, Miami, FL ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS 370
Transcript of Association of Allogeneic Red Blood Cell Transfusion with Surgeon Case Volume
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS370
<0.001). Similar race and gender trends were observed within eachage category. Conclusion: The ISS possesses excellent discrimina-tory ability in all populations as indicated by the high ROC’s. Theslight differences in its discriminatory capability by ethnicity andgender further emphasize the importance of adjusting for these cova-riates in any analysis. Further studies should be conducted to inves-tigate these ethnic and gender differences.
51.16. The Business Case for the Reduction of SurgicalComplications. M. Vaughan-Sarrazin, L. Bayman, G.Rosenthal, J. Cullen; University of Iowa, Iowa City, IA
Objectives: Surgical complications contribute significantly to costs.Most importantly, surgical complications contribute to morbidityand mortality and some may be preventable. This study estimatescosts of specific surgical complications for patients undergoing gen-eral surgery in VA hospitals using merged data from the VHA Na-tional Surgical Quality Improvement Program (NSQIP) and VADecision Support System (DSS). Methods: NSQIP provides detailedinformation on preoperative risk factors and on the occurrence of 19specific postoperative complications in patients undergoing surgeryin all VHA hospitals, while DSS provides detailed cost data of all hos-pitalizations within VHA using state-of-the-art cost accountingmethods. Costs associated with 19 potentially preventable complica-tions within six broader categories were estimated using generalizedlinear mixed regression models to control for patient-level determi-nants of costs (e.g., type of surgery, demographics, comorbidity, sever-ity) and hospital-level variation in costs. Costs included costs of theindex hospitalization and subsequent 30 day readmissions. Results:In 15,076 patients undergoing general surgical procedures from 10/2005 through 9/2006, 28% of patients developed postoperative surgi-cal complications. The presence of any complication significantly in-creased unadjusted costs nearly 3-fold ($59750 vs. $20,910), withthe largest cost differential attributed to respiratory complications(Table). Patients who developed complications had several markersfor greater pre-operative severity, including increased age and lowerpre-surgery functional health status. After controlling for differencesin patient severity, costs for patients with any complication were 1.67(p<.0001) times greater compared to costs for patients with no compli-cations. Within major complication categories, adjusted costs were1.95, 1.46, 1.46, 1.67, 1.58, and 1.30 times higher for patients with re-spiratory, cardiac, central nervous system, urinary, wound, or othercomplications (all P-values< 0.0001).
*P< 0.0001 vs. no complicationConclusions: Surgical complications contribute significantly to costsof inpatient surgeries. Investment in quality improvement thatreduces surgical complications could decrease costs.
51.17. Economic and Outcome-Based Analysis of Symptom-atic Varicose Vein Treatment. J. L. Eidson, III, M. D.Atkins, Jr, W. T. Bohannon, C. J. Buckley, R. L. Bush; Scott& White Hospital, Texas A & M University College ofMedicine, Temple, TX
Objective: Endoluminal treatment of symptomatic varicose veins(VV) has been confirmed to reduce inpatient stay and complicationrates as well as increase revenue for centers adopting this technique.This study demonstrates the impact of non-parallel cohorts, both interms of outcomes and economics, on a single center vascular service.Methods: Outpatient radiofrequency ablation (RFA) of symptomaticVV has been performed since May 2007 at our institution. A cohort of100 RFA patients (26% CEAP class C5/C6) were compared to 100 pa-tients who underwent traditional greater saphenous vein ligation andstripping (GSVL; 18% C5/C6) (August 2002-October 2007). The timeframes were chosen to allow at least 6-month follow-up. Patientswho had adjunctive removal of secondary varicosities were includedin both cohorts. Cost calculations are based on 2007-dollar hospitalcharges and do not include professional fees. Results: The resultsare presented in Table 1:
Reflux was successfully eliminated in 99% of RFA patients at 6months. The direct and indirect per patient costs associated with per-forming RFA in an outpatient clinic were $1180.23 vs. $10,101.53 forGSVL in the operating room setting. Conclusions: The establish-ment of a minimally invasive treatment program for VV has rapidlyincreased volume at our institution in a short period of time due tolack of hospitalization as well as immediate return to work and leisureactivity. Furthermore, GSVL was associated with more need for fol-low-up visits and considerably higher costs than endovenous ablationperformed in an outpatient treatment room setting.
51.18. Association of Allogeneic Red Blood Cell Transfusionwith Surgeon Case Volume. J. C. Pham, E. R. Haut, C. L.Catlett, S. M. Berenholtz; Johns Hopkins University,Baltimore, MD
Background: Surgeon case-volume predicts a variety of patientoutcomes. We hypothesize that surgeon case-volume predicts RBCtransfusion across different surgical procedures. Methods: Weperformed a cohort study of 372,670 inpatient surgical cases in the52 non-federal hospitals in Maryland between 2004 and 2005. Themain outcome measure was relative risk of receiving a transfusion.Results: Overall, 13.9% of patients received a transfusion. Patientsseen by the highest case-volume surgeons (>161 cases/yr) weremore likely to receive a transfusion (16% vs 11%, p< 0.01) comparedto middle case-volume surgeons (89-161 cases/yr). After adjusting forconfounders, the highest case-volume patients were still at increasedrisk of transfusion (RR 1.10, 1.07-1.14). This result was true acrossmany surgery types. Conclusions: Surgeon case-volume is indepen-dently associated with the likelihood of RBC transfusion acrossa broad range of surgical procedures. Future efforts should bedirected towards studying and standardization of transfusionpractices.
51.19. Does Having Insurance Lead to Better Patient Educa-tion? A Study of 533 Patients. Y. Zhuge, C. Schulman,M. C. Cheung, P. Ramos, M. de la Cruz, O. C. Velazquez;University of Miami Miller School of Medicine, Miami, FL
