Tags

Type your tag names separated by a space and hit enter

A higher hospital case mix index increases the odds of achieving a textbook outcome after hepatopancreatic surgery in the Medicare population.
Surgery. 2021 11; 170(5):1525-1531.S

Abstract

BACKGROUND

The objective of the current study was to assess the impact of case mix index at the hospital level on postoperative outcomes among Medicare beneficiaries who underwent hepatopancreatic surgery.

METHODS

Medicare beneficiaries who underwent hepatopancreatic surgery between 2013 and 2017 were identified and analyzed. The primary independent variable, Case Mix Index, is a freely available metric; the primary outcome was textbook outcome defined as the absence of complications, extended length of stay, readmission, and mortality.

RESULTS

Among 37,412 Medicare beneficiaries, 64.9% (n = 24,299) underwent a pancreatectomy and 35.1% (n = 13,113) underwent hepatectomy. The overall incidence of textbook outcome was 47.2%, which varied by case mix index (low case mix index: 41.6% vs high case mix index: 51.3%), as did extended length of stay (low case mix index: 27.9% versus high case mix index: 19.3%), complications (low case mix index: 33.3% vs high case mix index: 24.7%), and 90-day mortality (low case mix index: 12.5% vs high case mix index: 6.3%). After controlling for hepatopancreatic-specific surgical volume and hospital teaching status, multivariable analyses revealed that patients who underwent surgery at a low case mix index hospital had 28% decreased odds (95% confidence interval 0.66-0.79) of achieving a textbook outcome versus patients from a high case mix index hospital. Moreover, patients at a low case mix index hospital had 39% increased odds of extended length of stay (95% confidence interval 1.23-1.59), 48% increased odds of experiencing a complication (95% confidence interval 1.32-1.65), and 56% increased odds of 90-day mortality (95% confidence interval 1.31-1.87).

CONCLUSION

Case mix index was strongly associated with the probability of achieving a textbook outcome after hepatopancreatic surgery. Hospitals with a higher case mix index were more likely to perform hepatopancreatic surgeries with no adverse postoperative outcomes.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Hyer JM
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH. Electronic address: https://twitter.com/MadisonHyer.
Tsilimigras DI
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH. Electronic address: https://twitter.com/DTsilimigras.
Diaz A
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Mirdad RS
Royal College of Surgeons, Dublin, Ireland.
Pawlik TM
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH. Electronic address: tim.pawlik@osumc.edu.

MeSH

AgedDiagnosis-Related GroupsDigestive System Surgical ProceduresFemaleHumansMaleMedicareTreatment OutcomeUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34090674

Citation

Hyer, J Madison, et al. "A Higher Hospital Case Mix Index Increases the Odds of Achieving a Textbook Outcome After Hepatopancreatic Surgery in the Medicare Population." Surgery, vol. 170, no. 5, 2021, pp. 1525-1531.
Hyer JM, Tsilimigras DI, Diaz A, et al. A higher hospital case mix index increases the odds of achieving a textbook outcome after hepatopancreatic surgery in the Medicare population. Surgery. 2021;170(5):1525-1531.
Hyer, J. M., Tsilimigras, D. I., Diaz, A., Mirdad, R. S., & Pawlik, T. M. (2021). A higher hospital case mix index increases the odds of achieving a textbook outcome after hepatopancreatic surgery in the Medicare population. Surgery, 170(5), 1525-1531. https://doi.org/10.1016/j.surg.2021.05.013
Hyer JM, et al. A Higher Hospital Case Mix Index Increases the Odds of Achieving a Textbook Outcome After Hepatopancreatic Surgery in the Medicare Population. Surgery. 2021;170(5):1525-1531. PubMed PMID: 34090674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A higher hospital case mix index increases the odds of achieving a textbook outcome after hepatopancreatic surgery in the Medicare population. AU - Hyer,J Madison, AU - Tsilimigras,Diamantis I, AU - Diaz,Adrian, AU - Mirdad,Rayyan S, AU - Pawlik,Timothy M, Y1 - 2021/06/03/ PY - 2021/02/08/received PY - 2021/05/04/revised PY - 2021/05/08/accepted PY - 2021/6/7/pubmed PY - 2021/12/15/medline PY - 2021/6/6/entrez SP - 1525 EP - 1531 JF - Surgery JO - Surgery VL - 170 IS - 5 N2 - BACKGROUND: The objective of the current study was to assess the impact of case mix index at the hospital level on postoperative outcomes among Medicare beneficiaries who underwent hepatopancreatic surgery. METHODS: Medicare beneficiaries who underwent hepatopancreatic surgery between 2013 and 2017 were identified and analyzed. The primary independent variable, Case Mix Index, is a freely available metric; the primary outcome was textbook outcome defined as the absence of complications, extended length of stay, readmission, and mortality. RESULTS: Among 37,412 Medicare beneficiaries, 64.9% (n = 24,299) underwent a pancreatectomy and 35.1% (n = 13,113) underwent hepatectomy. The overall incidence of textbook outcome was 47.2%, which varied by case mix index (low case mix index: 41.6% vs high case mix index: 51.3%), as did extended length of stay (low case mix index: 27.9% versus high case mix index: 19.3%), complications (low case mix index: 33.3% vs high case mix index: 24.7%), and 90-day mortality (low case mix index: 12.5% vs high case mix index: 6.3%). After controlling for hepatopancreatic-specific surgical volume and hospital teaching status, multivariable analyses revealed that patients who underwent surgery at a low case mix index hospital had 28% decreased odds (95% confidence interval 0.66-0.79) of achieving a textbook outcome versus patients from a high case mix index hospital. Moreover, patients at a low case mix index hospital had 39% increased odds of extended length of stay (95% confidence interval 1.23-1.59), 48% increased odds of experiencing a complication (95% confidence interval 1.32-1.65), and 56% increased odds of 90-day mortality (95% confidence interval 1.31-1.87). CONCLUSION: Case mix index was strongly associated with the probability of achieving a textbook outcome after hepatopancreatic surgery. Hospitals with a higher case mix index were more likely to perform hepatopancreatic surgeries with no adverse postoperative outcomes. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/34090674/A_higher_hospital_case_mix_index_increases_the_odds_of_achieving_a_textbook_outcome_after_hepatopancreatic_surgery_in_the_Medicare_population_ DB - PRIME DP - Unbound Medicine ER -