Unbound MEDLINE

Surgeon volume is associated with cost and variation in surgical treatment of proximal humeral fractures.

Abstract

BACKGROUND : The issue of rising costs will likely dominate the healthcare debate in the forthcoming years.
QUESTIONS/PURPOSES
We assessed factors including surgeon volume that were associated with lower hospital costs and variations in surgical treatment for proximal humeral fractures.
METHODS
We used national databases for 2001 to 2008 to extract information on 25,731 patients undergoing surgery for proximal humeral fractures. We calculated hospital cost by converting hospital charges based on the hospital accounting reports collected by the Centers for Medicare & Medicaid Services.
RESULTS
In a multivariate linear regression analysis, higher surgeon volume, open reduction and internal fixation (versus hemiarthroplasty), and lower burden of comorbidities were associated with lower hospital cost. Higher surgeon volume was linearly associated with lower hospital costs such that, on average, adjusting for all other factors, a surgeon performing 20 shoulder arthroplasties per year saves a hospital approximately US $1800 per surgery. Factors associated with higher utilization of hemiarthroplasty included high surgeon volume (odds ratio [OR] = 1.46; 95% CI = 1.43, 1.97; as compared with low surgeon volume) and earlier years of our study period (OR = 0.61; 95% CI = 0.56, 0.66; for hemiarthroplasty in 2007-2008 versus 2001-2002).
CONCLUSIONS
Higher surgeon volume was associated with lower hospital costs for proximal humeral fractures. Therefore, policies on minimum volume requirements by hospitals may result in substantial cost savings. There is provider-based practice variation in the surgical treatment of proximal humeral fractures and evidence-based guidelines in this area are needed.
LEVEL OF EVIDENCE
Level III, economic analysis. See Instructions for Authors for a complete description of levels of evidence.

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  • Publisher Full Text

    • Authors

    Jain NB, Kuye I, Higgins LD, Warner JJ

    Institution

    Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, BC-4-016, Boston, MA 02115, USA. njain1@partners.org

    Source

    Clinical orthopaedics and related research 471:2 2013 Feb pg 655-64

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22826013