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Ann Thorac Surg 2001;72:334-340
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Hospital volume is related to clinical and economic outcomes of esophageal resection in Maryland

Justin B. Dimick, MDa, Stephen M. Cattaneo, MDa, Pamela A. Lipsett, MDa,b, Peter J. Pronovost, MD, PhDa,b,c, Richard F. Heitmiller, MDa

a Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
b Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
c Department of Health Policy and Management, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland, USA

Address reprint requests to Dr Heitmiller, The Johns Hopkins Hospital, Department of Surgery, 600 N Wolfe St, Osler 624, Baltimore, MD 21287-4605
e-mail: rheitmil{at}jhmi.edu

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. Previous studies have documented a relationship between hospital volume and perioperative and economic outcomes. Our objective was to determine the effect of hospital volume on outcomes of esophageal resection.

Methods. Statewide database was analyzed for patients who underwent esophageal resection in Maryland (n = 1,136 patients) from 1984 to 1999. Multivariate regression was used to determine the association of hospital volume with in-hospital mortality, length of stay, and charges after adjusting for case mix and time period.

Results. Unadjusted in-hospital mortality rates were lower in high volume hospitals (2.7%) than medium (12.7%) and low (16%) volume hospitals (p < 0.001). High hospital volume was associated with (1) fivefold reduction in the risk of death (odds ratio, 0.21; 95% confidence interval, 0.10 to 0.42; p < 0.001); (2) a 6-day (95% confidence interval, 5 to 7 days; p < 0.001) reduction in length of stay; and (3) $11,673 (95% confidence interval, $9,504 to $12,841; p < 0.001) decrease in hospital charges.

Conclusions. Hospitals that perform high volumes of esophageal resection have superior clinical and economic outcomes. By referring these patients to high volume centers, we may improve quality and reduce costs.


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