Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries

Elham Mahmoudi, PhD; Yiwen Lu, MS; Shu-Chen Chang, PhD; Chia-Yu Lin, Msc; Yi-Chun Wang, MS; Chee Jen Chang, PhD; Ming-Huei Cheng, MD, MBA; Kevin C. Chung, MD, MS

doi:10.1097/GOX.0000000000001520

Plastic and Reconstructive Surgery, Global Open (Oct 2017)

Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries

Elham Mahmoudi, PhD,
Yiwen Lu, MS,
Shu-Chen Chang, PhD,
Chia-Yu Lin, Msc,
Yi-Chun Wang, MS,
Chee Jen Chang, PhD,
Ming-Huei Cheng, MD, MBA,
Kevin C. Chung, MD, MS

Affiliations

Elham Mahmoudi, PhD: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Yiwen Lu, MS: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Shu-Chen Chang, PhD: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Chia-Yu Lin, Msc: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Yi-Chun Wang, MS: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Chee Jen Chang, PhD: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ming-Huei Cheng, MD, MBA: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Kevin C. Chung, MD, MS: From the *Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich.; †Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.; ‡Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; §Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ¶Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; ‖Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; **Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; and ††Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

DOI: https://doi.org/10.1097/GOX.0000000000001520
Journal volume & issue: Vol. 5, no. 10
p. e1520

Abstract

Read online

Background:. We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS. Methods:. Using Taiwan’s national data (2001–2012), we conducted a retrospective cohort study of all adults 18–64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day. Results:. Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11–1.55) and high-volume surgeons (OR = 1.16; CI,1.03–1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small. Conclusions:. There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

About the journal