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Assessing the Costs Associated with Volume-Based Referral for Hepatic Surgery
1Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street Blalock 688, Baltimore, MD, 21287, USA.
Summary
High-volume hospitals reduce liver surgery complications and failure-to-rescue rates. However, managing complications at these centers incurs significantly higher costs, impacting overall economic consequences.
Area of Science:
- Health Economics
- Surgical Outcomes
- Hospital Quality Metrics
Background:
- Volume-based referral is proposed for quality improvement, but its economic impact is understudied.
- Understanding the financial consequences of hospital volume is crucial for healthcare policy.
Purpose of the Study:
- To investigate the relationship between inpatient costs and hospital volume for elective liver surgery.
- To analyze the economic impact of hospital volume on surgical outcomes and complication management.
Main Methods:
- Utilized the Nationwide Inpatient Sample (2001-2012) for elective liver surgery patients.
- Performed multivariable hierarchical regression analyses to compare risk-adjusted costs and outcomes across hospital volume terciles.
Main Results:
- No significant cost differences were found across hospital volume groups.
- Postoperative complications significantly increased overall costs (median $17,974 vs. $41,731).
- High-volume hospitals showed lower complication (13.0%) and failure-to-rescue (15.1%) rates, but higher "rescue" costs ($48,559).
Conclusions:
- Improved outcomes at high-volume hospitals, particularly for patients with complications, are associated with increased costs.
- The economic implications of volume-based care require careful consideration, balancing quality improvements with financial burdens.
