The Association Between Number of Hospital Advanced Practice Providers and Surgical Morbidity

Area of Science:

• Oncology
• Surgical Outcomes
• Healthcare Management

Background:

• Previous studies show similar quality of care by advanced practice providers (APPs) for medical admissions.
• The impact of APP integration on morbidity after cancer surgery remains unexamined.
• This study investigates APP staffing intensity and outcomes in major abdominal cancer surgery.

Purpose of the Study:

• To assess the relationship between advanced practice provider (APP) staffing intensity and patient outcomes following major abdominal cancer surgery.
• To analyze the association between APP-to-bed ratios and surgical outcomes.
• To evaluate the effect of APP staffing on readmission rates, length of stay, and perioperative mortality.

Main Methods:

• Utilized national Medicare data from 2010-2019 for patients undergoing major abdominal cancer surgery.
• Defined primary exposure as the ratio of APPs per 100 hospital beds, categorized into tertiles.
• Analyzed outcomes including readmission rates, length of stay, and 30-day perioperative mortality, adjusting for patient and hospital factors.

Main Results:

• Analyzed data from over 470,000 patients across various abdominal cancer surgeries.
• Higher APP staffing was associated with shorter lengths of stay for most procedures.
• Unadjusted readmission rates varied by procedure complexity, but clinical outcome differences were lost when controlling for hospital factors.

Conclusions:

• The association between hospital APP staffing intensity and surgical outcomes is varied and heterogeneous.
• Observed outcome differences were primarily explained by hospital-level factors, not APP intensity alone.
• Further research is needed to identify specific processes related to inpatient APP deployment.