The volume-outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score...

Area of Science:

• Health Economics
• Surgical Outcomes Research
• Health Services Research

Background:

• The volume-outcome relationship is established for surgical procedures and cancer treatments.
• Longitudinal comparisons and systematic analyses of laparoscopic cholecystectomy (LC) outcomes in Taiwan are lacking.
• This study investigates the link between surgical volume and hospital treatment costs for LC.

Purpose of the Study:

• To explore the relationship between hospital and surgeon volume and the associated hospital treatment cost for laparoscopic cholecystectomy (LC).
• To identify factors influencing hospital resource utilization in LC procedures.

Main Methods:

• Retrospective cohort study of 247,751 LC procedures from 1998 to 2009 in Taiwan.
• Hospitals and surgeons categorized into low-, medium-, and high-volume groups based on annual LC case numbers.
• Hierarchical linear regression and propensity score analysis employed to assess volume-cost relationships.

Main Results:

• Average hospital treatment cost for LC was US $2,504.53.
• High-volume hospitals and surgeons demonstrated significantly lower treatment costs (33-47% reduction compared to low-volume counterparts).
• Propensity score analysis confirmed significant cost differences between high-volume and low/medium-volume providers (P < 0.001).

Conclusions:

• A significant association exists between high-volume hospitals/surgeons and reduced hospital treatment costs for LC patients.
• Key factors influencing resource utilization include patient age, gender, comorbidity, and hospital/surgeon volume.
• Adopting treatment strategies from high-volume centers may enhance overall cost-effectiveness for LC.