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. 2015 Jun 8;10(6):e0129178.
doi: 10.1371/journal.pone.0129178. eCollection 2015.

Which Kind of Provider's Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan

Tsung-Hsien Yu  1 , Yu-Chi Tung  1 , Kuo-Piao Chung  1
Affiliations

Which Kind of Provider's Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan

Tsung-Hsien Yu et al. PLoS One. .

Abstract

Background: Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG) surgical site infections (SSIs) as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented.

Methods: A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from 19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes and a Classification and Regression Trees (CART) model. Two definitions of surgeon and hospital operation volumes were used: (1) the cumulative CABG operation volumes within the study period; and (2) the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1) a continuous variable; (2) a categorical variable based on the quartile; and (3) a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted.

Results: This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon's volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons.

Conclusion: Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and SSIs in Taiwan. However, the relationships were not robust. Definitions and categorization methods of operation volume and correct identification of SSIs are important issues for future research.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Scatter plot: hospital cumulative operation volumes within the study period.
Fig 2
Fig 2. Scatter plot: surgeon cumulative operation volumes within the study period.
Fig 3
Fig 3. Scatter plot: hospital cumulative operation volumes in the previous one year before surgery.
Fig 4
Fig 4. Scatter plot: surgeon cumulative operation volumes in the previous one year before surgery.
See this image and copyright information in PMC

References

    1. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301(25):1364–9. - PubMed
    1. Song XY, Cosgrove SE, Pass MA, Perl TM. Using hospital claim data to monitor surgical site infections for inpatient procedures. Am J Infect Control. 2008;36(3):S32–S6.
    1. Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005;140(2):174–82. - PubMed
    1. Huang SS, Placzek H, Livingston J, Ma A, Onufrak F, Lankiewicz J, et al. Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery. Infect Control Hosp Epidemiol. 2011;32(8):775–83. 10.1086/660874 - DOI - PubMed
    1. Lee J, Imanaka Y, Sekimoto M, Nishikawa H, Ikai H, Motohashi T, et al. Validation of a novel method to identify healthcare-associated infections. J Hosp Infect. 2011;77(4):316–20. 10.1016/j.jhin.2010.11.013 - DOI - PubMed