Volume creates value: The volume–outcome relationship in Scandinavian obesity surgery
This study establishes the relationship between surgical volume and cost and quality outcomes, using patient-level clinical data from a national quality registry for bariatric surgery in Sweden. Data include patient characteristics with comorbidities, surgical and follow-up data for patients that un...
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| Veröffentlicht in: | HEALTH SERVICES MANAGEMENT RESEARCH 2022-11, Vol.35 (4), p.229-239 |
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| creator | Svarts, Anna Anders, Thorell Engwall, Mats |
| description | This study establishes the relationship between surgical volume and cost and quality outcomes, using patient-level clinical data from a national quality registry for bariatric surgery in Sweden. Data include patient characteristics with comorbidities, surgical and follow-up data for patients that underwent gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703 patients in 51 hospitals). The relationships between surgical volume (annual number of bariatric procedures) and several patient-level outcomes were assessed using multilevel, mixed-effect regression models, controlling for patient characteristics and comorbidities. We found that hospitals with higher volumes had lower risk of intraoperative complications as well as complications within 30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87, respectively, p |
| doi_str_mv | 10.1177/09514848211048598 |
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Data include patient characteristics with comorbidities, surgical and follow-up data for patients that underwent gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703 patients in 51 hospitals). The relationships between surgical volume (annual number of bariatric procedures) and several patient-level outcomes were assessed using multilevel, mixed-effect regression models, controlling for patient characteristics and comorbidities. We found that hospitals with higher volumes had lower risk of intraoperative complications as well as complications within 30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87, respectively, p<0.01). In addition, higher-volume hospitals had substantially shorter procedure time (17 min per 100 procedures, p<0.01) and length of stay (0.88 incidence-rate ratio per 100 procedures p<0.01). Our results support the claim that increased surgical volume significantly improves quality. Further, the results strongly suggest that increased volume leads to lower cost per surgery, by reducing cost drivers such as procedure time and length of stay.</description><identifier>ISSN: 0951-4848</identifier><identifier>ISSN: 1758-1044</identifier><identifier>EISSN: 1758-1044</identifier><identifier>DOI: 10.1177/09514848211048598</identifier><identifier>PMID: 35125029</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>adult ; bariatric surgery ; Bariatric Surgery - methods ; cohort analysis ; comorbidity ; controlled study ; correlation analysis ; female ; follow up ; Gastric Bypass ; Gastric Bypass - methods ; gastric bypass surgery ; Gastric restriction surgery ; Gastrointestinal surgery ; health care cost ; health care quality ; hospital ; Hospitals ; human ; Humans ; incidence ; Length of stay ; major clinical study ; male ; Medicin och hälsovetenskap ; Morbid ; morbid obesity ; multilevel analysis ; multilevel modeling ; Obesity ; Obesity, Morbid - surgery ; odds ratio ; operation duration ; patient outcome ; patient safety ; peroperative complication ; Postoperative care ; postoperative complication ; Primary Research ; procedures ; quality registry ; register ; Registries ; regression model ; risk factor ; Scandinavia ; sleeve gastrectomy ; Surgery ; Surgical volume ; Sweden ; treatment outcome</subject><ispartof>HEALTH SERVICES MANAGEMENT RESEARCH, 2022-11, Vol.35 (4), p.229-239</ispartof><rights>The Author(s) 2022</rights><rights>The Author(s) 2022 2022 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c592t-321c51f0b6ad7d408816aa8ad30614b8edf742b402b9ca4c8c687d5d34ce386a3</citedby><cites>FETCH-LOGICAL-c592t-321c51f0b6ad7d408816aa8ad30614b8edf742b402b9ca4c8c687d5d34ce386a3</cites><orcidid>0000-0002-7660-5300</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/09514848211048598$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/09514848211048598$$EHTML$$P50$$Gsage$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,780,784,885,21819,27924,27925,30999,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35125029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-320810$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:235125029$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Svarts, Anna</creatorcontrib><creatorcontrib>Anders, Thorell</creatorcontrib><creatorcontrib>Engwall, Mats</creatorcontrib><title>Volume creates value: The volume–outcome relationship in Scandinavian obesity surgery</title><title>HEALTH SERVICES MANAGEMENT RESEARCH</title><addtitle>Health Serv Manage Res</addtitle><description>This study establishes the relationship between surgical volume and cost and quality outcomes, using patient-level clinical data from a national quality registry for bariatric surgery in Sweden. Data include patient characteristics with comorbidities, surgical and follow-up data for patients that underwent gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703 patients in 51 hospitals). The relationships between surgical volume (annual number of bariatric procedures) and several patient-level outcomes were assessed using multilevel, mixed-effect regression models, controlling for patient characteristics and comorbidities. We found that hospitals with higher volumes had lower risk of intraoperative complications as well as complications within 30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87, respectively, p<0.01). In addition, higher-volume hospitals had substantially shorter procedure time (17 min per 100 procedures, p<0.01) and length of stay (0.88 incidence-rate ratio per 100 procedures p<0.01). Our results support the claim that increased surgical volume significantly improves quality. Further, the results strongly suggest that increased volume leads to lower cost per surgery, by reducing cost drivers such as procedure time and length of stay.</description><subject>adult</subject><subject>bariatric surgery</subject><subject>Bariatric Surgery - methods</subject><subject>cohort analysis</subject><subject>comorbidity</subject><subject>controlled study</subject><subject>correlation analysis</subject><subject>female</subject><subject>follow up</subject><subject>Gastric Bypass</subject><subject>Gastric Bypass - methods</subject><subject>gastric bypass surgery</subject><subject>Gastric restriction surgery</subject><subject>Gastrointestinal surgery</subject><subject>health care cost</subject><subject>health care quality</subject><subject>hospital</subject><subject>Hospitals</subject><subject>human</subject><subject>Humans</subject><subject>incidence</subject><subject>Length of stay</subject><subject>major clinical study</subject><subject>male</subject><subject>Medicin och hälsovetenskap</subject><subject>Morbid</subject><subject>morbid obesity</subject><subject>multilevel analysis</subject><subject>multilevel modeling</subject><subject>Obesity</subject><subject>Obesity, Morbid - surgery</subject><subject>odds ratio</subject><subject>operation duration</subject><subject>patient outcome</subject><subject>patient safety</subject><subject>peroperative complication</subject><subject>Postoperative care</subject><subject>postoperative complication</subject><subject>Primary Research</subject><subject>procedures</subject><subject>quality registry</subject><subject>register</subject><subject>Registries</subject><subject>regression model</subject><subject>risk factor</subject><subject>Scandinavia</subject><subject>sleeve gastrectomy</subject><subject>Surgery</subject><subject>Surgical volume</subject><subject>Sweden</subject><subject>treatment outcome</subject><issn>0951-4848</issn><issn>1758-1044</issn><issn>1758-1044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>D8T</sourceid><recordid>eNp9ks1OGzEQx62qCFLgAXqpVup5wfbaXruHSoi2gITEoRSOlteeJIbNOrV3U-XWd-gb9klwSPhSRU_-mN_8_zNjI_Se4ANC6voQK06YZJISgpnkSr5BI1JzWeYje4tGq3i5AnbQu5RuMMaSCLGNdipOKMdUjdD1VWiHGRQ2gukhFQvTDvCpuJxCsbiP_P39Jwy9DZmJ0Jrehy5N_bzwXfHdms75ziy86YrQQPL9skhDnEBc7qGtsWkT7G_WXfTj29fL49Py_OLk7PjovLRc0b6sKLGcjHEjjKsdwzIXaIw0rsKCsEaCG9eMNgzTRlnDrLRC1o67ilmopDDVLirXuukXzIdGz6OfmbjUwXi9ubrNO9CMc6FE5tWr_DwG95T0kEgfhvVfry_-6kiHONG3_VRXNA8aZ_7zms_wDJyFro-mfWn5ItL5qZ6EhVa8ZgrzLPBxIxDDzwFSr2_CELs8T01rmh-WCrpqiawpG0NKEcaPDgTr1T_R__yTnPPheWmPGc96Pdj0aibwZPu64h31ecnv</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Svarts, Anna</creator><creator>Anders, Thorell</creator><creator>Engwall, Mats</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AFDQA</scope><scope>AOWAS</scope><scope>D8T</scope><scope>D8V</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-7660-5300</orcidid></search><sort><creationdate>20221101</creationdate><title>Volume creates value: The volume–outcome relationship in Scandinavian obesity surgery</title><author>Svarts, Anna ; Anders, Thorell ; Engwall, Mats</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c592t-321c51f0b6ad7d408816aa8ad30614b8edf742b402b9ca4c8c687d5d34ce386a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>adult</topic><topic>bariatric surgery</topic><topic>Bariatric Surgery - methods</topic><topic>cohort analysis</topic><topic>comorbidity</topic><topic>controlled study</topic><topic>correlation analysis</topic><topic>female</topic><topic>follow up</topic><topic>Gastric Bypass</topic><topic>Gastric Bypass - methods</topic><topic>gastric bypass surgery</topic><topic>Gastric restriction surgery</topic><topic>Gastrointestinal surgery</topic><topic>health care cost</topic><topic>health care quality</topic><topic>hospital</topic><topic>Hospitals</topic><topic>human</topic><topic>Humans</topic><topic>incidence</topic><topic>Length of stay</topic><topic>major clinical study</topic><topic>male</topic><topic>Medicin och hälsovetenskap</topic><topic>Morbid</topic><topic>morbid obesity</topic><topic>multilevel analysis</topic><topic>multilevel modeling</topic><topic>Obesity</topic><topic>Obesity, Morbid - surgery</topic><topic>odds ratio</topic><topic>operation duration</topic><topic>patient outcome</topic><topic>patient safety</topic><topic>peroperative complication</topic><topic>Postoperative care</topic><topic>postoperative complication</topic><topic>Primary Research</topic><topic>procedures</topic><topic>quality registry</topic><topic>register</topic><topic>Registries</topic><topic>regression model</topic><topic>risk factor</topic><topic>Scandinavia</topic><topic>sleeve gastrectomy</topic><topic>Surgery</topic><topic>Surgical volume</topic><topic>Sweden</topic><topic>treatment outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Svarts, Anna</creatorcontrib><creatorcontrib>Anders, Thorell</creatorcontrib><creatorcontrib>Engwall, Mats</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SWEPUB Kungliga Tekniska Högskolan full text</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Kungliga Tekniska Högskolan</collection><collection>SwePub Articles full text</collection><jtitle>HEALTH SERVICES MANAGEMENT RESEARCH</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Svarts, Anna</au><au>Anders, Thorell</au><au>Engwall, Mats</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Volume creates value: The volume–outcome relationship in Scandinavian obesity surgery</atitle><jtitle>HEALTH SERVICES MANAGEMENT RESEARCH</jtitle><addtitle>Health Serv Manage Res</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>35</volume><issue>4</issue><spage>229</spage><epage>239</epage><pages>229-239</pages><issn>0951-4848</issn><issn>1758-1044</issn><eissn>1758-1044</eissn><abstract>This study establishes the relationship between surgical volume and cost and quality outcomes, using patient-level clinical data from a national quality registry for bariatric surgery in Sweden. Data include patient characteristics with comorbidities, surgical and follow-up data for patients that underwent gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703 patients in 51 hospitals). The relationships between surgical volume (annual number of bariatric procedures) and several patient-level outcomes were assessed using multilevel, mixed-effect regression models, controlling for patient characteristics and comorbidities. We found that hospitals with higher volumes had lower risk of intraoperative complications as well as complications within 30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87, respectively, p<0.01). In addition, higher-volume hospitals had substantially shorter procedure time (17 min per 100 procedures, p<0.01) and length of stay (0.88 incidence-rate ratio per 100 procedures p<0.01). Our results support the claim that increased surgical volume significantly improves quality. Further, the results strongly suggest that increased volume leads to lower cost per surgery, by reducing cost drivers such as procedure time and length of stay.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>35125029</pmid><doi>10.1177/09514848211048598</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7660-5300</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | HEALTH SERVICES MANAGEMENT RESEARCH, 2022-11, Vol.35 (4), p.229-239 |
| issn | 0951-4848 1758-1044 1758-1044 |
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| source | MEDLINE; SWEPUB Freely available online; Applied Social Sciences Index & Abstracts (ASSIA); SAGE Complete A-Z List |
| subjects | adult bariatric surgery Bariatric Surgery - methods cohort analysis comorbidity controlled study correlation analysis female follow up Gastric Bypass Gastric Bypass - methods gastric bypass surgery Gastric restriction surgery Gastrointestinal surgery health care cost health care quality hospital Hospitals human Humans incidence Length of stay major clinical study male Medicin och hälsovetenskap Morbid morbid obesity multilevel analysis multilevel modeling Obesity Obesity, Morbid - surgery odds ratio operation duration patient outcome patient safety peroperative complication Postoperative care postoperative complication Primary Research procedures quality registry register Registries regression model risk factor Scandinavia sleeve gastrectomy Surgery Surgical volume Sweden treatment outcome |
| title | Volume creates value: The volume–outcome relationship in Scandinavian obesity surgery |
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