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A variation in the value of colectomy for cancer across hospitals: mortality, readmissions, and costs.
Surgery. 2014 Oct; 156(4):849-56, 860.S

Abstract

INTRODUCTION

Although hospital variation in costs and outcomes has been described for patients undergoing operation, the relationship between them is unknown. The purpose of this study was to evaluate this relationship among patients undergoing colon resection for cancer and identify characteristics of "high-quality, low-cost" hospitals.

METHODS

We identified adult patients who underwent colon resection for cancer in California, Florida, and New York from 2009 to 2010. We estimated hospital-level, risk-standardized 30-day hospital costs, in-hospital mortality rates, and 30-day readmission rates by using hierarchical generalized linear models. Costs were compared between hospitals identified as low, average, and high performers.

RESULTS

The final sample included 14,790 patients discharged from 389 hospitals. After adjusting for case mix, variation was noted in risk-standardized costs (median = $26,169, inter-quartile range [IQR] = $6,559), in-hospital mortality (median = 1.8%, IQR = 2.3%), and 30-day readmission (12.2%, IQR = 0.7%) rates. Minimal correlation was noted between a hospital's costs and outcomes, with similar costs noted across hospital performance groups (low = $25,994 vs average = $26,998 vs high = $25,794, P = .19). High-quality, low-cost hospitals treated a greater percentage of Medicare beneficiaries, approached fewer cases laparoscopically, and trended toward greater volume.

CONCLUSION

Hospital costs are not correlated with outcomes in this population. More work is needed to identify means of providing high-quality care at lesser costs.

Authors+Show Affiliations

Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH. Electronic address: justin_p_fox@yahoo.com.Section of Colon and Rectal Surgery, Division of General Surgery, Washington University School of Medicine, St. Louis, MO.VA Palo Alto Healthcare System, Palo Alto, CA.Department of Emergency Medicine, University of California San Francisco, San Francisco, CA.Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

25239333

Citation

Fox, Justin P., et al. "A Variation in the Value of Colectomy for Cancer Across Hospitals: Mortality, Readmissions, and Costs." Surgery, vol. 156, no. 4, 2014, pp. 849-56, 860.
Fox JP, Tyler JA, Vashi AA, et al. A variation in the value of colectomy for cancer across hospitals: mortality, readmissions, and costs. Surgery. 2014;156(4):849-56, 860.
Fox, J. P., Tyler, J. A., Vashi, A. A., Hsia, R. Y., & Saxe, J. M. (2014). A variation in the value of colectomy for cancer across hospitals: mortality, readmissions, and costs. Surgery, 156(4), 849-56, 860. https://doi.org/10.1016/j.surg.2014.06.011
Fox JP, et al. A Variation in the Value of Colectomy for Cancer Across Hospitals: Mortality, Readmissions, and Costs. Surgery. 2014;156(4):849-56, 860. PubMed PMID: 25239333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A variation in the value of colectomy for cancer across hospitals: mortality, readmissions, and costs. AU - Fox,Justin P, AU - Tyler,Joshua A, AU - Vashi,Anita A, AU - Hsia,Renee Y, AU - Saxe,Jonathan M, PY - 2014/01/29/received PY - 2014/06/18/accepted PY - 2014/9/21/entrez PY - 2014/9/23/pubmed PY - 2014/11/14/medline SP - 849-56, 860 JF - Surgery JO - Surgery VL - 156 IS - 4 N2 - INTRODUCTION: Although hospital variation in costs and outcomes has been described for patients undergoing operation, the relationship between them is unknown. The purpose of this study was to evaluate this relationship among patients undergoing colon resection for cancer and identify characteristics of "high-quality, low-cost" hospitals. METHODS: We identified adult patients who underwent colon resection for cancer in California, Florida, and New York from 2009 to 2010. We estimated hospital-level, risk-standardized 30-day hospital costs, in-hospital mortality rates, and 30-day readmission rates by using hierarchical generalized linear models. Costs were compared between hospitals identified as low, average, and high performers. RESULTS: The final sample included 14,790 patients discharged from 389 hospitals. After adjusting for case mix, variation was noted in risk-standardized costs (median = $26,169, inter-quartile range [IQR] = $6,559), in-hospital mortality (median = 1.8%, IQR = 2.3%), and 30-day readmission (12.2%, IQR = 0.7%) rates. Minimal correlation was noted between a hospital's costs and outcomes, with similar costs noted across hospital performance groups (low = $25,994 vs average = $26,998 vs high = $25,794, P = .19). High-quality, low-cost hospitals treated a greater percentage of Medicare beneficiaries, approached fewer cases laparoscopically, and trended toward greater volume. CONCLUSION: Hospital costs are not correlated with outcomes in this population. More work is needed to identify means of providing high-quality care at lesser costs. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/25239333/A_variation_in_the_value_of_colectomy_for_cancer_across_hospitals:_mortality_readmissions_and_costs_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(14)00329-8 DB - PRIME DP - Unbound Medicine ER -