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Volume-outcome relation for acute appendicitis: evidence from a nationwide population-based study
Po-Li Wei1, Shih-Ping Liu, Joseph J Keller
1Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Plos One
|January 10, 2013
Summary
Surgeon volume significantly impacts appendicitis outcomes. Lower surgeon volume is linked to higher rates of perforated appendicitis, indicating a need to consider surgeon experience for quality care.
Area of Science:
- Surgical Quality Improvement
- Health Services Research
- Gastrointestinal Surgery
Background:
- Appendectomy is a common procedure, but surgeon-specific volume impact on appendicitis rupture is understudied.
- Assessing surgeon experience is crucial for understanding appendicitis care quality.
Purpose of the Study:
- To investigate the association between surgeon case volume and the rate of ruptured appendicitis.
- To evaluate surgeon volume as a quality indicator for appendicitis treatment using national data.
Main Methods:
- Analysis of 65,339 hospitalizations for acute appendicitis (ICD-9-CM codes 540-540.9) from 2007-2009.
- Used perforated appendicitis as the primary outcome measure.
- Employed conditional logistic regression to assess odds of perforation across surgeon volume groups.
Main Results:
- Patients treated by low-volume surgeons exhibited higher morbidity (28.1%) compared to high-volume (21.4%-26.15%).
- After adjusting for covariates, low-volume surgeons had significantly higher odds of causing perforated appendicitis (ORs ranging from 1.09 to 1.54).
Conclusions:
- Surgeon case volume is a significant determinant of perforated appendicitis rates.
- Higher surgeon volume is associated with better quality of care in appendicitis treatment.
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