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Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries
Elham Mahmoudi1, Yiwen Lu1, Shu-Chen Chang1
1Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Background:
We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS.
Methods:
Using Taiwan's national data (2001-2012), we conducted a retrospective cohort study of all adults 18-64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day.
Results:
Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11-1.55) and high-volume surgeons (OR = 1.16; CI,1.03-1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small.
Conclusions:
There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan.
