High Volume Hospitals are Associated With Decreased Rates of Non-Routine Discharge Following Single-Level Cervical
Paul G Mastrokostas1,2, Bruce B Zhang1, Aaron B Lavi1
1Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Insights
High-volume hospitals improve discharge outcomes for cervical disc arthroplasty (CDA) but increase costs. Disseminating best practices from high-volume centers to lower-volume hospitals is crucial for better patient care and cost management.
Area of Science:
- Neurosurgery
- Health Services Research
- Orthopedic Surgery
Background:
- Hospital volume is a critical factor influencing patient outcomes in complex surgical procedures.
- Single-level cervical disc arthroplasty (CDA) is increasingly performed, necessitating an understanding of factors affecting its success.
- Variations in hospital volume may lead to disparities in postoperative care and resource utilization.
Purpose of the Study:
- To investigate the association between hospital volume and postoperative outcomes after single-level cervical disc arthroplasty (CDA).
- To analyze the impact of hospital volume on non-routine discharge rates, length of stay (LOS), and hospital costs.
- To identify potential strategies for improving CDA care across different hospital settings.
Main Methods:
- Retrospective cohort study utilizing the National Inpatient Sample (NIS) database (2016-2020).
- Inclusion of 14,315 weighted cases of single-level CDA, stratified by hospital volume (low, intermediate, high).
- Multivariate logistic and linear regression analyses adjusted for patient demographics and comorbidities to assess outcomes.
Main Results:
- High-volume hospitals demonstrated significantly lower odds of non-routine discharge compared to low- and intermediate-volume hospitals.
- Patients treated at high-volume hospitals incurred significantly higher hospital costs than those at low-volume hospitals.
- No significant difference in length of stay was observed across different hospital volume categories.
Conclusions:
- Higher hospital volume in single-level CDA is linked to better discharge outcomes but higher associated costs.
- There is a need to implement practices from high-volume centers in lower-volume settings to optimize patient care.
- Further research into outpatient settings and long-term results is recommended to enhance CDA patient management.
Abstract:
Study DesignRetrospective cohort study.ObjectivesThis study aims to evaluate the impact of hospital volume on postoperative outcomes following single-level cervical disc arthroplasty (CDA), focusing on non-routine discharge rates, length of stay (LOS), and hospital costs.MethodsAfter applying the appropriate exclusion criteria, the National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients undergoing single-level CDA between 2016 and 2020. Patients were stratified by hospital volume into low, intermediate, and high categories based on annual case numbers. Multivariate logistic regression evaluated odds of non-routine discharge and complications, while linear regression analyzed LOS and hospital costs. Models were adjusted for age, sex, and comorbidities. Statistical significance was set at P < .05.ResultsPatients in high-volume hospitals had significantly lower odds of non-routine discharge compared to both intermediate-volume (OR: 0.63, 95% CI: 0.44-0.91, P = .014) and low-volume hospitals (OR: 0.66, 95% CI: 0.45-0.98, P = .040). Patients in high-volume hospitals also incurred significantly higher costs compared to low-volume hospitals (coefficient: $1,232.22, 95% CI: $189.05-$2,275.38, P = .021), while length of stay did not differ significantly across volume categories.ConclusionsHigh-volume hospitals are associated with improved discharge outcomes, but also increased costs following single-level CDA. These findings underscore the need to disseminate high-volume center practices to lower-volume hospitals while addressing cost management. Further research should explore the impact of outpatient settings and long-term outcomes to enhance care delivery for CDA patients.
