The volume-outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching

doi:10.1007/s00464-013-2867-x

Chia Nan University of Pharmacy & Science Institutional Repository > 藥理學院 > 化妝品應用與管理系(所) > 期刊論文 > Item 310902800/27946

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標題:	The volume-outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching
作者:	Shi, Hon-Yi Lee, King-Teh Chiu, Chong-Chi Lee, Hao-Hsien
貢獻者:	化妝品應用管理系
關鍵字:	Hospital Volume Surgeon Volume Outcome Laparoscopic Cholecystectomy
日期:	2013-09
上傳時間:	2014-05-26 10:50:08 (UTC+8)
出版者:	Springer
摘要:	The volume-outcome relationship has been validated previously for surgical procedures and cancer treatments. However, no studies have longitudinally compared the relationships between volume and outcome, and none have systematically compared laparoscopic cholecystectomy (LC) surgery outcomes in Taiwan. This study purposed to explore the relationship between volume and hospital treatment cost after LC.This cohort study retrospectively analyzed 247,751 LCs performed from 1998 to 2009. Hospitals were classified as low-, medium-, and high-volume hospitals if their annual number of LCs were 1-29, 30-84, a parts per thousand yen85, respectively. Surgeons were classified as low-, medium-, and high-volume surgeons if their annual number of LCs were 1-10, 11-24, a parts per thousand yen25, respectively. Hierarchical linear regression model and propensity score were used to assess the relationship between volume and hospital treatment cost.The mean hospital treatment cost was US $2,504.53, and the average hospital costs for high-volume hospitals/surgeons were 33/47 % lower than those for low-volume hospitals and surgeons. When analyzed by propensity score, the hospital treatment cost differed significantly between high-volume hospitals/surgeons and low/medium-volume hospitals/surgeons (2,073.70 vs. 2,350.91/2,056.73 vs. 2,553.76, P < 0.001).Analysis using a hierarchical linear regression model and propensity score found an association between high-volume hospitals and surgeons and hospital treatment cost in LC patients. Moreover, the significant factors associated with hospital resource utilization for this procedure include age, gender, comorbidity, hospital type, hospital volume, and surgeon volume. Additionally, analysis of the treatment strategies adopted at high-volume hospitals or by high-volume surgeons may improve overall hospital treatment cost.
關聯:	Surgical Endoscopy And Other Interventional Techniques, v.27 n.9, pp.3139-3145
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