The Norwood operation: Relative effects of surgeon and institutional volumes on outcomes and resource utilization

Brett R. Anderson, Adam J. Ciarleglio, David J. Cohen, Wyman W. Lai, Matthew Neidell, Matthew Hall, Sharon Glied, Emile A. Bacha

Research output: Contribution to journalArticle

Abstract

Background: Hypoplastic left heart syndrome is the most expensive birth defect managed in the United States, with a 5-year survival rate below 70%. Increasing evidence suggests that hospital volumes are inversely associated with mortality for infants with single ventricles undergoing stage 1 surgical palliation. Our aim was to examine the relative effects of surgeon and institutional volumes on outcomes and resource utilisation for these children. Methods: A retrospective study was conducted using the Pediatric Health Information System database to examine the effects of the number of procedures performed per surgeon and per centre on mortality, costs, and post-operative length of stay for infants undergoing Risk Adjustment for Congenital Heart Surgery risk category six operations at tertiary-care paediatric hospitals, from 1 January, 2004 to 31 December, 2013. Multivariable modelling was used, adjusting for patient and institutional characteristics. Gaussian kernel densities were constructed to show the relative distributions of the effects of individual institutions and surgeons, before and after adjusting for the number of cases performed. Results: A total of 2880 infants from 35 institutions met the inclusion criteria. Mortality was 15.0%. Median post-operative length of stay was 24 days (IQR 14–41). Median standardized inpatient hospital costs were $156,000 (IQR $108,000–$248,000) in 2013 dollars. In the multivariable analyses, higher institutional volume was inversely associated with mortality (p=0.001), post-operative length of stay (p=0.004), and costs (p=0.001). Surgeon volume was associated with none of the measured outcomes. Neither institutional nor surgeon volumes explained much of the wide variation in outcomes and resource utilization observed between institutions and between surgeons. Conclusions: Increased institutional – but not surgeon – volumes are associated with reduced mortality, post-operative length of stay, and costs for infants undergoing stage 1 palliation.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalCardiology in the Young
DOIs
StateAccepted/In press - Jul 14 2015

Fingerprint

Norwood Procedures
Length of Stay
Mortality
Costs and Cost Analysis
Hypoplastic Left Heart Syndrome
Health Information Systems
Risk Adjustment
Pediatric Hospitals
Hospital Costs
Infant Mortality
Tertiary Healthcare
Surgeons
Thoracic Surgery
Inpatients
Survival Rate
Retrospective Studies
Databases
Pediatrics

Keywords

  • costs
  • Hypoplastic left heart syndrome
  • Norwood
  • outcomes
  • surgeon volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Anderson, B. R., Ciarleglio, A. J., Cohen, D. J., Lai, W. W., Neidell, M., Hall, M., ... Bacha, E. A. (Accepted/In press). The Norwood operation: Relative effects of surgeon and institutional volumes on outcomes and resource utilization. Cardiology in the Young, 1-10. https://doi.org/10.1017/S1047951115001031

The Norwood operation : Relative effects of surgeon and institutional volumes on outcomes and resource utilization. / Anderson, Brett R.; Ciarleglio, Adam J.; Cohen, David J.; Lai, Wyman W.; Neidell, Matthew; Hall, Matthew; Glied, Sharon; Bacha, Emile A.

In: Cardiology in the Young, 14.07.2015, p. 1-10.

Research output: Contribution to journalArticle

Anderson, Brett R. ; Ciarleglio, Adam J. ; Cohen, David J. ; Lai, Wyman W. ; Neidell, Matthew ; Hall, Matthew ; Glied, Sharon ; Bacha, Emile A. / The Norwood operation : Relative effects of surgeon and institutional volumes on outcomes and resource utilization. In: Cardiology in the Young. 2015 ; pp. 1-10.
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AU - Anderson, Brett R.

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AU - Neidell, Matthew

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AU - Glied, Sharon

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AB - Background: Hypoplastic left heart syndrome is the most expensive birth defect managed in the United States, with a 5-year survival rate below 70%. Increasing evidence suggests that hospital volumes are inversely associated with mortality for infants with single ventricles undergoing stage 1 surgical palliation. Our aim was to examine the relative effects of surgeon and institutional volumes on outcomes and resource utilisation for these children. Methods: A retrospective study was conducted using the Pediatric Health Information System database to examine the effects of the number of procedures performed per surgeon and per centre on mortality, costs, and post-operative length of stay for infants undergoing Risk Adjustment for Congenital Heart Surgery risk category six operations at tertiary-care paediatric hospitals, from 1 January, 2004 to 31 December, 2013. Multivariable modelling was used, adjusting for patient and institutional characteristics. Gaussian kernel densities were constructed to show the relative distributions of the effects of individual institutions and surgeons, before and after adjusting for the number of cases performed. Results: A total of 2880 infants from 35 institutions met the inclusion criteria. Mortality was 15.0%. Median post-operative length of stay was 24 days (IQR 14–41). Median standardized inpatient hospital costs were $156,000 (IQR $108,000–$248,000) in 2013 dollars. In the multivariable analyses, higher institutional volume was inversely associated with mortality (p=0.001), post-operative length of stay (p=0.004), and costs (p=0.001). Surgeon volume was associated with none of the measured outcomes. Neither institutional nor surgeon volumes explained much of the wide variation in outcomes and resource utilization observed between institutions and between surgeons. Conclusions: Increased institutional – but not surgeon – volumes are associated with reduced mortality, post-operative length of stay, and costs for infants undergoing stage 1 palliation.

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