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Differentiating among hospitals performing physiologically complex operative procedures in the elderly
Ruth E Wachtel1, Franklin Dexter
1Department of Anesthesia, University of Iowa, Iowa City, 52242, USA.
Insights
Discharge abstract data can compare surgical practices for elderly patients, though hospitals performing complex procedures are not easily differentiated. One hospital specialized in rare geriatric procedures, attracting patients from afar.
Area of Science:
- Health Services Research
- Surgical Outcomes Analysis
Background:
- Previous work demonstrated statewide discharge abstract databases can quantify inter-hospital variations in surgical practices.
- Two Iowa pediatric hospitals offer diverse, complex procedures to younger patients, with complex pediatric surgery regionalized to high-volume centers.
Purpose of the Study:
- To quantify physiologically complex operative procedures in elderly patients (80+ years) using the same discharge abstract database.
- To compare surgical practice patterns for geriatric patients with those previously observed for pediatric patients.
Main Methods:
- Utilized an inpatient discharge abstract database for Iowa.
- Analyzed physiologically complex operative procedures performed in patients aged 80 years and older between January and June 2001.
Main Results:
- Hospitals performing complex geriatric procedures were not easily differentiated by volume or type, unlike pediatric centers (P < 0.001).
- One hospital showed a higher volume of rare geriatric procedures and attracted patients from outside their local county.
- Statistical analysis revealed significant differences in procedure distribution between geriatric and pediatric patient groups.
Conclusions:
- Findings support the validity and utility of discharge abstract data for comparing surgical practices across facilities for elderly patients.
- Discharge abstract data can help various stakeholders understand unique hospital contributions to surgical care.
Background:
The authors previously showed how a statewide discharge abstract database could be used to quantify for stakeholders how surgical practices differ among hospitals. The two pediatric hospitals in Iowa differ from other hospitals in Iowa based on their providing a more diverse, comprehensive, and physiologically complex selection of procedures in younger patients. Physiologically complex surgery performed in children aged 0-2 yr has been regionalized to a few high-volume facilities.
Methods:
The same inpatient discharge abstract database was used to quantify physiologically complex operative procedures performed throughout Iowa in patients aged 80 yr and older during January through June 2001.
Results:
In contrast to earlier results with pediatric patients using the same database, hospitals performing physiologically complex procedures in the elderly could not readily be differentiated from one another based on the numbers and types of procedures performed (P < 0.001 when comparing geriatrics vs. pediatrics in terms of the distributions of numbers of procedures, the distributions of numbers of different types of procedures, or the distributions of numbers of rare procedures performed at different hospitals). Additional analyses showed that one hospital did perform relatively more rare procedures in geriatric patients and had a relatively larger percentage of patients who traveled beyond their local county to reach it.
Conclusions:
Results observed for geriatric patients provide further evidence of the validity of these methods and the usefulness of discharge abstract data for comparing surgical practices among facilities. A hospital can use discharge abstract data to assist governmental agencies, charitable organizations, philanthropists, insurers, etc., in appreciating the unique contributions of individual hospitals to surgical care.
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