TY - JOUR
T1 - Surgeon volume is associated with cost and variation in surgical treatment of proximal humeral fractures shoulder
AU - Jain, Nitin B.
AU - Kuye, Ifedayo
AU - Higgins, Laurence D.
AU - Warner, Jon J.P.
N1 - Funding Information:
We used the Nationwide Inpatient Sample (NIS) databases for 2001 through 2008. The NIS is managed by the Healthcare Cost and Utilization Project, that is made possible by a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality [3]. The NIS is a 20% stratified sample of community hospitals in the United States [2]. The NIS sampled hospitals according to five hospital characteristics: geographic region (North-east, North Central, West, and South); ownership (public, private not-for-profit, and private investor-owned); location (urban, rural); teaching status (teaching hospital, nonteaching hospital); and bed size (small, medium, and large).
PY - 2013/2
Y1 - 2013/2
N2 - Background: The issue of rising costs will likely dominate the healthcare debate in the forthcoming years. Questions/Purposes: We assessed factors including surgeon volume that were associated with lower hospital costs and variations in surgical treatment for proximal humeral fractures. Methods: We used national databases for 2001 to 2008 to extract information on 25,731 patients undergoing surgery for proximal humeral fractures. We calculated hospital cost by converting hospital charges based on the hospital accounting reports collected by the Centers for Medicare & Medicaid Services. Results: In a multivariate linear regression analysis, higher surgeon volume, open reduction and internal fixation (versus hemiarthroplasty), and lower burden of comorbidities were associated with lower hospital cost. Higher surgeon volume was linearly associated with lower hospital costs such that, on average, adjusting for all other factors, a surgeon performing 20 shoulder arthroplasties per year saves a hospital approximately US 1800 per surgery. Factors associated with higher utilization of hemiarthroplasty included high surgeon volume (odds ratio [OR] = 1.46; 95% CI = 1.43, 1.97; as compared with low surgeon volume) and earlier years of our study period (OR = 0.61; 95% CI = 0.56, 0.66; for hemiarthroplasty in 2007-2008 versus 2001-2002). Conclusions: Higher surgeon volume was associated with lower hospital costs for proximal humeral fractures. Therefore, policies on minimum volume requirements by hospitals may result in substantial cost savings. There is provider-based practice variation in the surgical treatment of proximal humeral fractures and evidence-based guidelines in this area are needed. Level of Evidence: Level III, economic analysis. See Instructions for Authors for a complete description of levels of evidence.
AB - Background: The issue of rising costs will likely dominate the healthcare debate in the forthcoming years. Questions/Purposes: We assessed factors including surgeon volume that were associated with lower hospital costs and variations in surgical treatment for proximal humeral fractures. Methods: We used national databases for 2001 to 2008 to extract information on 25,731 patients undergoing surgery for proximal humeral fractures. We calculated hospital cost by converting hospital charges based on the hospital accounting reports collected by the Centers for Medicare & Medicaid Services. Results: In a multivariate linear regression analysis, higher surgeon volume, open reduction and internal fixation (versus hemiarthroplasty), and lower burden of comorbidities were associated with lower hospital cost. Higher surgeon volume was linearly associated with lower hospital costs such that, on average, adjusting for all other factors, a surgeon performing 20 shoulder arthroplasties per year saves a hospital approximately US 1800 per surgery. Factors associated with higher utilization of hemiarthroplasty included high surgeon volume (odds ratio [OR] = 1.46; 95% CI = 1.43, 1.97; as compared with low surgeon volume) and earlier years of our study period (OR = 0.61; 95% CI = 0.56, 0.66; for hemiarthroplasty in 2007-2008 versus 2001-2002). Conclusions: Higher surgeon volume was associated with lower hospital costs for proximal humeral fractures. Therefore, policies on minimum volume requirements by hospitals may result in substantial cost savings. There is provider-based practice variation in the surgical treatment of proximal humeral fractures and evidence-based guidelines in this area are needed. Level of Evidence: Level III, economic analysis. See Instructions for Authors for a complete description of levels of evidence.
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U2 - 10.1007/s11999-012-2481-6
DO - 10.1007/s11999-012-2481-6
M3 - Article
C2 - 22826013
AN - SCOPUS:84878227271
SN - 0009-921X
VL - 471
SP - 655
EP - 664
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 2
ER -