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. 2003 Aug;238(2):161-7.
doi: 10.1097/01.SLA.0000081094.66659.c3.

Hospital volume, length of stay, and readmission rates in high-risk surgery

Philip P Goodney  1 , Therese A Stukel, F Lee Lucas, Emily V A Finlayson, John D Birkmeyer
Affiliations

Hospital volume, length of stay, and readmission rates in high-risk surgery

Philip P Goodney et al. Ann Surg. 2003 Aug.

Abstract

Objective: Aimed at reducing surgical deaths, several recent initiatives have attempted to establish volume-based referral strategies in high-risk surgery. Although payers are leading the most visible of these efforts, it is unknown whether volume standards will also reduce resource use.

Methods: We studied postoperative length of stay and 30-day readmission rate after 14 cardiovascular and cancer procedures using the 1994-1999 national Medicare database (total n = 2.5 million). We used regression techniques to examine the relationship between length of stay, 30-day readmission, and hospital volume, adjusting for age, gender, race, comorbidity score, admission acuity, and mean social security income.

Results: Mean postoperative length of stay ranged from 3.4 days (carotid endarterectomy) to 19.6 days (esophagectomy). There was no consistent relationship between volume and mean length of stay; it significantly increased across volume strata for 7 of the 14 procedures and significantly decreased across volume strata for the other 7. Mean length of stay at very-low-volume and very-high-volume hospitals differed by more than 1 day for 6 procedures. Of these, the mean length of stay was shorter in high-volume hospitals for 3 procedures (pancreatic resection, esophagectomy, cystectomy), but longer for other procedures (aortic and mitral valve replacement, gastrectomy). The 30-day readmission rate also varied widely by procedure, ranging from 9.9% (nephrectomy) to 22.2% (mitral valve replacement). However, volume was not related to 30-day readmission rate with any procedure.

Conclusion: Although hospital volume may be an important predictor of operative mortality, it is not associated with resource use as reflected by length of stay or readmission rates.

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Figures

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FIGURE 1. (a) Mean postoperative length of stay for 6 cardiovascular procedures, based on data from the national Medicare population (1994–1999). P < 0.05 for all differences across volume strata. (b) Mean postoperative length of stay for 8 cancer resections, based on data from the national Medicare population (1994–1999). P < 0.05 for all differences across volume strata.
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References

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