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Open AccessArticle

The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy

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Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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T. H. Chan Harvard School of Public Health, Boston, MA 02115, USA
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Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC 27599-7065, USA
*
Author to whom correspondence should be addressed.
Presented at 2018 AATS International Thoracic Surgical Oncology Summit, 12–13 October 2018, New York, NY, USA.
Medicina 2019, 55(10), 669; https://doi.org/10.3390/medicina55100669
Received: 19 June 2019 / Revised: 20 September 2019 / Accepted: 30 September 2019 / Published: 3 October 2019
Background and Objectives: Previous studies have demonstrated superior patient outcomes for thoracic oncology patients treated at high-volume surgery centers compared to low-volume centers. However, the specific role of overall hospital size in open esophagectomy morbidity and mortality remains unclear. Materials and Methods: Patients aged >18 years who underwent open esophagectomy for primary malignant neoplasia of the esophagus between 2002 and 2014 were identified using the National Inpatient Sample. Minimally invasive procedures were excluded. Discharges were stratified by hospital size (large, medium, and small) and analyzed using trend and multivariable regression analyses. Results: Over a 13-year period, a total of 69,840 open esophagectomy procedures were performed nationally. While the proportion of total esophagectomies performed did not vary by hospital size, in-hospital mortality trends decreased for all hospitals (large (7.2% to 3.7%), medium (12.8% vs. 4.9%), and small (12.8% vs. 4.9%)), although this was only significant for large hospitals (P < 0.01). After controlling for patient demographics, comorbidities, admission, and hospital-level factors, hospital length of stay (LOS), total inflation-adjusted costs, in-hospital mortality, and complications (cardiac, respiratory, vascular, and bleeding) did not vary by hospital size (all P > 0.05). Conclusions: After risk adjustment, patient morbidity and in-hospital mortality appear to be comparable across all institutions, including small hospitals. While there appears to be an increased push for referring patients to large hospitals, our findings suggest that there may be other factors (such as surgeon type, hospital volume, or board status) that are more likely to impact the results; these need to be further explored in the current era of episode-based care. View Full-Text
Keywords: open esophagectomy; hospital size; esophageal cancer open esophagectomy; hospital size; esophageal cancer
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Hirji, S.A.; Shah, R.M.; Fields, A.; Orhurhu, V.; Bhulani, N.; White, A.; Mody, G.N.; Swanson, S.J. The Impact of Hospital Size on National Trends and Outcomes Following Open Esophagectomy. Medicina 2019, 55, 669.

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