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Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery
Alexandra I Stavrakis1, Philip H G Ituarte, Clifford Y Ko
1Endocrine Surgical Unit and Center for Surgical Outcomes and Quality, VA Greater Los Angeles Healthcare System, Los Angeles, Calif., USA.
Background:
Surgeon experience correlates with improved outcomes for complex operations. Endocrine operations are increasingly performed in the outpatient setting, where outcomes have not been systematically studied. We examined the effect of surgeon volume on clinical and economic outcomes for thyroid, parathyroid, and adrenal surgery across inpatient and outpatient settings.
Methods:
New York and Florida state discharge data (2002) were studied. Surgeons were grouped by annual endocrine operative volume: Group A, 1 to 3 operations; B, 4 to 8; C, 9 to 19; D, 20 to 50; E, 51 to 99; and F, >or=100. Multiple regression analyses were applied to analyze complications, length of stay (LOS), and total charges (TC), while controlling for comorbidity, economic factors, and hospital-centric variables.
Results:
We identified 13,997 discharges, with 28% of operations performed on an outpatient basis (admission/discharge on same calendar day). For all cases, group A contributed disproportionately more complications (observed/expected [O/E] 1.65, P < .001) and Group F contributed disproportionately less (0.52; P < .001). High surgeon volume was associated with decreased LOS and reduced TC. Hospital volume had a negligible effect on outcomes.
Conclusions:
Surgeon volume correlates inversely with complication rates, LOS, and TC, in endocrine surgery. The lowest complication rates are achieved by surgeons performing >or=100 endocrine operations annually.