Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics?

James M. Clark, David T Cooke, Habiba Hashimi, David Chin, Garth H Utter, Lisa M Brown, Miriam A Nuno

Research output: Contribution to journal › Article

Abstract

Objective: We examine how esophagectomy volume thresholds reflect outcomes relative to patient characteristics. Summary Background Data: Esophagectomy outcomes are associated with surgeon and hospital operative volumes, leading the Leapfrog Group to recommend minimum annual volume thresholds of 7 and 20 respectively. Methods: Patients undergoing esophagectomy for cancer were identified from the 2007-2013 New York and Florida Healthcare Cost and Utilization Projects State Inpatient Databases. Logit models adjusted for patient characteristics evaluated in-hospital mortality, complications, and prolonged length of stay (PLOS). Median surgeon and hospital volumes were compared between young-healthy (age 18-57, Elixhauser Comorbidity Index [ECI] <2) and older-sick patients (age -71, ECI >4). Results: Of 4330 esophagectomy patients, 3515 (81%) were male, median age was 64 (interquartile range 58-71), and mortality was 4.0%. Patients treated by both low-volume surgeons and hospitals had the greatest mortality risk (5.0%), except in the case of older-sick patients mortality was highest at high-volume hospitals with high-volume surgeons (12%). For mortality <1%, annual hospital and surgeon volumes needed were 23 and 8, respectively; mortality rose to 4.2% when volumes dropped to the Leapfrog thresholds of 20 and 7, respectively. Complication rose from 53% to 63% when hospital and surgeon volumes decreased from 28 and 10 to 19 and 7, respectively. PLOS rose from 19% to 27% when annual hospital and surgeon volumes decreased from 27 and 8 to 20 and 7, respectively. Conclusions: Current Leapfrog Group esophagectomy volume guidelines may not predict optimal outcomes for all patients, especially at extremes of age and comorbidities.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Esophagectomy
Demography
Mortality
Comorbidity
Length of Stay
Low-Volume Hospitals
High-Volume Hospitals
Hospital Mortality
Surgeons
Health Care Costs
Inpatients
Logistic Models
Databases
Guidelines
Neoplasms

Keywords

  • centralization
  • esophagectomy
  • regionalization
  • surgical volume
  • The Leapfrog Group
  • volume thresholds

ASJC Scopus subject areas

  • Surgery

Cite this

Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics? / Clark, James M.; Cooke, David T; Hashimi, Habiba; Chin, David; Utter, Garth H; Brown, Lisa M; Nuno, Miriam A.

In: Annals of Surgery, 01.01.2019.

Research output: Contribution to journal › Article

Clark, JM, Cooke, DT, Hashimi, H, Chin, D, Utter, GH, Brown, LM & Nuno, MA 2019, 'Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics?', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000003553
Clark JM, Cooke DT, Hashimi H, Chin D, Utter GH, Brown LM et al. Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics? Annals of Surgery. 2019 Jan 1. https://doi.org/10.1097/SLA.0000000000003553
Clark, James M. ; Cooke, David T ; Hashimi, Habiba ; Chin, David ; Utter, Garth H ; Brown, Lisa M ; Nuno, Miriam A. / Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics?. In: Annals of Surgery. 2019.
@article{a3292b9714474246b8f29ded495af458,
title = "Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics?",
abstract = "Objective: We examine how esophagectomy volume thresholds reflect outcomes relative to patient characteristics. Summary Background Data: Esophagectomy outcomes are associated with surgeon and hospital operative volumes, leading the Leapfrog Group to recommend minimum annual volume thresholds of 7 and 20 respectively. Methods: Patients undergoing esophagectomy for cancer were identified from the 2007-2013 New York and Florida Healthcare Cost and Utilization Projects State Inpatient Databases. Logit models adjusted for patient characteristics evaluated in-hospital mortality, complications, and prolonged length of stay (PLOS). Median surgeon and hospital volumes were compared between young-healthy (age 18-57, Elixhauser Comorbidity Index [ECI] <2) and older-sick patients (age -71, ECI >4). Results: Of 4330 esophagectomy patients, 3515 (81{\%}) were male, median age was 64 (interquartile range 58-71), and mortality was 4.0{\%}. Patients treated by both low-volume surgeons and hospitals had the greatest mortality risk (5.0{\%}), except in the case of older-sick patients mortality was highest at high-volume hospitals with high-volume surgeons (12{\%}). For mortality <1{\%}, annual hospital and surgeon volumes needed were 23 and 8, respectively; mortality rose to 4.2{\%} when volumes dropped to the Leapfrog thresholds of 20 and 7, respectively. Complication rose from 53{\%} to 63{\%} when hospital and surgeon volumes decreased from 28 and 10 to 19 and 7, respectively. PLOS rose from 19{\%} to 27{\%} when annual hospital and surgeon volumes decreased from 27 and 8 to 20 and 7, respectively. Conclusions: Current Leapfrog Group esophagectomy volume guidelines may not predict optimal outcomes for all patients, especially at extremes of age and comorbidities.",
keywords = "centralization, esophagectomy, regionalization, surgical volume, The Leapfrog Group, volume thresholds",
author = "Clark, {James M.} and Cooke, {David T} and Habiba Hashimi and David Chin and Utter, {Garth H} and Brown, {Lisa M} and Nuno, {Miriam A}",
year = "2019",
month = "1",
day = "1",
doi = "10.1097/SLA.0000000000003553",
language = "English (US)",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Do the 2018 Leapfrog Group Minimal Hospital and Surgeon Volume Thresholds for Esophagectomy Favor Specific Patient Demographics?

AU - Clark, James M.

AU - Cooke, David T

AU - Hashimi, Habiba

AU - Chin, David

AU - Utter, Garth H

AU - Brown, Lisa M

AU - Nuno, Miriam A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: We examine how esophagectomy volume thresholds reflect outcomes relative to patient characteristics. Summary Background Data: Esophagectomy outcomes are associated with surgeon and hospital operative volumes, leading the Leapfrog Group to recommend minimum annual volume thresholds of 7 and 20 respectively. Methods: Patients undergoing esophagectomy for cancer were identified from the 2007-2013 New York and Florida Healthcare Cost and Utilization Projects State Inpatient Databases. Logit models adjusted for patient characteristics evaluated in-hospital mortality, complications, and prolonged length of stay (PLOS). Median surgeon and hospital volumes were compared between young-healthy (age 18-57, Elixhauser Comorbidity Index [ECI] <2) and older-sick patients (age -71, ECI >4). Results: Of 4330 esophagectomy patients, 3515 (81%) were male, median age was 64 (interquartile range 58-71), and mortality was 4.0%. Patients treated by both low-volume surgeons and hospitals had the greatest mortality risk (5.0%), except in the case of older-sick patients mortality was highest at high-volume hospitals with high-volume surgeons (12%). For mortality <1%, annual hospital and surgeon volumes needed were 23 and 8, respectively; mortality rose to 4.2% when volumes dropped to the Leapfrog thresholds of 20 and 7, respectively. Complication rose from 53% to 63% when hospital and surgeon volumes decreased from 28 and 10 to 19 and 7, respectively. PLOS rose from 19% to 27% when annual hospital and surgeon volumes decreased from 27 and 8 to 20 and 7, respectively. Conclusions: Current Leapfrog Group esophagectomy volume guidelines may not predict optimal outcomes for all patients, especially at extremes of age and comorbidities.

AB - Objective: We examine how esophagectomy volume thresholds reflect outcomes relative to patient characteristics. Summary Background Data: Esophagectomy outcomes are associated with surgeon and hospital operative volumes, leading the Leapfrog Group to recommend minimum annual volume thresholds of 7 and 20 respectively. Methods: Patients undergoing esophagectomy for cancer were identified from the 2007-2013 New York and Florida Healthcare Cost and Utilization Projects State Inpatient Databases. Logit models adjusted for patient characteristics evaluated in-hospital mortality, complications, and prolonged length of stay (PLOS). Median surgeon and hospital volumes were compared between young-healthy (age 18-57, Elixhauser Comorbidity Index [ECI] <2) and older-sick patients (age -71, ECI >4). Results: Of 4330 esophagectomy patients, 3515 (81%) were male, median age was 64 (interquartile range 58-71), and mortality was 4.0%. Patients treated by both low-volume surgeons and hospitals had the greatest mortality risk (5.0%), except in the case of older-sick patients mortality was highest at high-volume hospitals with high-volume surgeons (12%). For mortality <1%, annual hospital and surgeon volumes needed were 23 and 8, respectively; mortality rose to 4.2% when volumes dropped to the Leapfrog thresholds of 20 and 7, respectively. Complication rose from 53% to 63% when hospital and surgeon volumes decreased from 28 and 10 to 19 and 7, respectively. PLOS rose from 19% to 27% when annual hospital and surgeon volumes decreased from 27 and 8 to 20 and 7, respectively. Conclusions: Current Leapfrog Group esophagectomy volume guidelines may not predict optimal outcomes for all patients, especially at extremes of age and comorbidities.

KW - centralization

KW - esophagectomy

KW - regionalization

KW - surgical volume

KW - The Leapfrog Group

KW - volume thresholds

UR - http://www.scopus.com/inward/record.url?scp=85070779989&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070779989&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000003553

DO - 10.1097/SLA.0000000000003553

M3 - Article

AN - SCOPUS:85070779989

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -

Access to Document