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Associations of Surgeon and Hospital Volumes with Outcome for Free Tissue Transfer by Using the National Taiwan Population Health Care Data from 2001 to 2012.

ABSTRACT: Greater hospital case volumes are associated with improved outcomes for high-risk procedures. The hospital-outcome association for complex but low-mortality procedures and the association between surgeon versus hospital case volume and surgical outcomes have been less explored. The authors examined the association between surgeon and hospital volume and the success for free tissue transfer (free flap) surgery. The authors hypothesized that there would be positive associations between hospital and surgeon volume and the success of free flap surgery.The study design was a cross-sectional analysis of adults aged 18 to 64 years who underwent free flap surgery. The authors used 100 percent of all free flap operations between 2001 and 2012 using Taiwan's national data that cover the entire population of 23 million in the country. The authors applied hierarchical regression modeling to analyze volume-outcome associations.The association between hospital volume and free flap success was small but positive (OR, 1.007; 95 percent CI, 1.00 to 1.01). For surgeons, their years of experience had a positive association with success of the operation (OR, 1.04; 95 percent CI, 1.02 to 1.06) rather than their annual case volume. Compared with low-volume surgeons (<11 annual cases) working in low-volume hospitals (<95 annual cases), high-volume surgeons (>25 annual cases) working in high-volume hospitals (>156 annual cases) showed greater odds of operation success (OR, 2.97; 95 percent CI, 1.21 to 7.29).Higher volume hospitals and more experienced surgeons, regardless of their annual volume, showed better outcomes. Increasing demand for high-quality care and Taiwan's national policies toward centralization of complex surgical procedures have increased competition among hospitals.Therapeutic, III.

SUBMITTER: Mahmoudi E

PROVIDER: S-EPMC5598770 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Associations of Surgeon and Hospital Volumes with Outcome for Free Tissue Transfer by Using the National Taiwan Population Health Care Data from 2001 to 2012.

Mahmoudi Elham E Lu Yiwen Y Chang Shu-Chen SC Lin Chia-Yu CY Wang Yi-Chun YC Chang Chee Jen CJ Cheng Ming-Huei MH Chung Kevin C KC

Plastic and reconstructive surgery 20170901 3

<h4>Background</h4>Greater hospital case volumes are associated with improved outcomes for high-risk procedures. The hospital-outcome association for complex but low-mortality procedures and the association between surgeon versus hospital case volume and surgical outcomes have been less explored. The authors examined the association between surgeon and hospital volume and the success for free tissue transfer (free flap) surgery. The authors hypothesized that there would be positive associations ...[more]

PMID: 28841623

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Project description:BackgroundMost studies showing a volume outcome effect in resection surgery for oesophago-gastric cancer were conducted before the centralisation of clinical services. This study evaluated the relation between hospital- and surgeon volume and different risk-adjusted outcomes after oesophago-gastric (OG) cancer surgery in England between 2011 and 2013.MethodsIn data from the National Oesophago-Gastric Cancer Audit from the UK, multivariable random-effects logistic regression models were used to quantify the effect of surgeon and hospital volume on three outcomes: 30-day and 90-day mortality and anastomotic leakage. The models included patient risk factors to adjust for differences in case-mix among hospitals and surgeons. The between-cluster heterogeneity was estimated with the median odds ratio (MOR).ResultsThe study included patients treated at 42 hospitals and 329 surgeons. The median (interquartile range) of the annual hospital and surgeon volumes were 110 patients (82 to 137) and 13 patients (8 to 19), respectively. The overall rates for 30-day and 90-day mortality were 2.3% and 4.4% respectively, and the anastomotic leakage was 6.3%. Higher hospital volume was associated with lower 30-day mortality (OR: 0.94; 95% CI: 0.91-0.98) and lower anastomotic leakage rates (OR: 0.96; 95% CI: 0.93-0.98) but not 90-day mortality. Higher surgeon volume was only associated with lower anastomotic leakage rates (OR: 0.81; 95% CI: 0.72-0.92). Hospital volume explained a part of the between-hospital variation in 30-day mortality whereas surgeon volume explained part of the between-hospital variation in anastomotic leakage.ConclusionsIn the setting of centralized O-G cancer surgery in England, we could still observe an effect of volume on short-term outcomes. However, the effect is inconsistent, depending on the type of outcome measure under consideration, and much smaller than in previous studies. Efforts to centralise O-G cancer services further should carefully address the effects of both hospital and surgeon volume on the range of outcome measures that are relevant to patients.

Project description:The purpose of this study was (1) to describe intakes of total grain and whole grain in the United States over the past 12 years and major dietary sources, and (2) to determine the relationship between whole grain intake and adiposity measures for children and adults.Cross-sectional dietary data from the continuous National Health and Nutrition Examination Survey 2001-12 (6 2-year cycles) for children 6-18 years (n = 15,280) and adults 19+ years (n = 29,683) were linked to the My Pyramid and Food Patterns Equivalents Databases to assess daily intake of total grain and whole grain. These populations were classified into groups based on average whole grain intake: 0 ounce equivalents (oz eq)/day, > 0 and <1 oz eq/day, and ≥1 oz eq/day. Within these classifications, body mass index, waist circumference, and percent overweight/obese were identified. Regression and logistic regression analyses were used to assess associations between these dependent variables and whole grain intake.Adults consumed a mean 0.72 whole grain oz eq/day in 2001-02 and 0.97 oz eq/day in 2011-12 and children consumed a mean 0.56 whole grain oz eq/day in 2001-02 and 0.74 oz eq/day in 2011-12. While over 70 % of children and 60 % of adults met daily intake recommendations for total grain, less than 1.0 and 8.0 % percent of children and adults, respectively, met whole grain recommendations in 2011-12. Adults and children who consumed whole grain had significantly better intakes of nutrients and dietary fiber compared to non-consumers. From 2001 to 2012, grain mixed dishes and yeast breads were the leading sources of total grain, while yeast breads and ready to eat cereals were the leading sources of whole grain for both children and adults. Multiple regression analysis showed a significant, inverse relationship between body mass index and waist circumference with respect to whole grain intake after adjustment for covariates in both children and adults (p < 0.05). Similarly, logistic regression analysis showed a significant inverse relationship between percent overweight/obese and whole grain intake (p < 0.05).Although most children and adults meet daily intake goals for grain foods overall, whole grain as a portion of total grain intake continues to be consumed at levels well below recommendations. The data from the current study suggest that greater whole grain consumption is associated with better intakes of nutrients and healthier body weight in children and adults. Continued efforts to promote increased intake of whole grain foods are warranted.

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Associations of Surgeon and Hospital Volumes with Outcome for Free Tissue Transfer by Using the National Taiwan Population Health Care Data from 2001 to 2012.

Publications

Associations of Surgeon and Hospital Volumes with Outcome for Free Tissue Transfer by Using the National Taiwan Population Health Care Data from 2001 to 2012.

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