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Published on: October 29, 2014
Outcomes after the regionalization of major surgical procedures in the Alberta Capital Health Region (Edmonton)
S M Hamilton1, W C Johnston, D C Voaklander
1Department of Surgery and Capital Health Authority, University of Alberta, Edmonton. shamilto@cha.ab.ca
Objective:
To evaluate the impact of regionalization on the outcomes of 16 surgical procedures performed in the Capital Health Region (Edmonton) of Alberta.
Design:
A computer search of hospital discharge abstracts coded for the Canadian Institute for Health Information.
Setting:
Two major hospitals in Edmonton.
Patients:
The study population comprised 9250 patients (9727 procedures [4524, pre-regionalization, 5203 post-regionalization]) who underwent any of 16 major procedures in the 2 years before and the 2 years after restructuring.
Outcome Measures:
Demographic data, Charlson's comorbidity index, number of urgent and emergent cases, death rate, average length of hospital stay and the readmission rate.
Results:
The post-regionalization patient group was slightly older, had a higher comorbidity index, and fewer urgent and emergent cases. The case volume increased by 15%, and 43.6% of patients used some form of community-based health care services. The median length of hospital stay decreased from 8.0 days pre-regionalization to 7.0 days post-regionalization (p < 0.001). Overall and for specific procedures the death rate was unchanged (3.1% pre-regionalization, 2.4% post-regionalization, p = 0.06). The readmission rates were similar for both groups (8.0% versus 7.0%).
Conclusions:
The consolidation of these 16 major surgical procedures had minimal impact on death and readmission rates even though patients in the post-regionalization group were slightly older and had greater comorbidity. There was a significant decline in the length of hospital stay, which occurred nationally over the same period, and a corresponding increase in the use of community-based services.
