Relation of surgical volume to outcome in eight common operations: Results from the VA National Surgical Quality Improvement Program

Shukri F. Khuri, Jennifer Daley, William Henderson, Kwan Hur, Monir Hossain, David Soybel, Kenneth W Kizer, J. Bradley Aust, Richard H. Bell, Vernon Chong, John Demakis, Peter J. Fabri, James O. Gibbs, Frederick Grover, Karl Hammermeister, Gerald McDonald, Edward Passaro, Lloyd Phillips, Frank Scamman, Jeannette SpencerJohn F. Stremple

Research output: Contribution to journalArticle

243 Citations (Scopus)

Abstract

Objective: To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data: In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods: The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results: Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions: In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care.

Original languageEnglish (US)
Pages (from-to)414-432
Number of pages19
JournalAnnals of Surgery
Volume230
Issue number3
DOIs
StatePublished - Sep 1999
Externally publishedYes

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Veterans Health
Quality Improvement
United States Department of Veterans Affairs
Carotid Endarterectomy
Stroke
Closing Volume
Surgical Specialties
Pneumonectomy
Mortality
Colectomy
Quality of Health Care
Laparoscopic Cholecystectomy
Arthroplasty
Blood Vessels
Hip
Analysis of Variance
Logistic Models
Delivery of Health Care
Lung

ASJC Scopus subject areas

  • Surgery

Cite this

Relation of surgical volume to outcome in eight common operations : Results from the VA National Surgical Quality Improvement Program. / Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Hossain, Monir; Soybel, David; Kizer, Kenneth W; Aust, J. Bradley; Bell, Richard H.; Chong, Vernon; Demakis, John; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Passaro, Edward; Phillips, Lloyd; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

In: Annals of Surgery, Vol. 230, No. 3, 09.1999, p. 414-432.

Research output: Contribution to journalArticle

Khuri, SF, Daley, J, Henderson, W, Hur, K, Hossain, M, Soybel, D, Kizer, KW, Aust, JB, Bell, RH, Chong, V, Demakis, J, Fabri, PJ, Gibbs, JO, Grover, F, Hammermeister, K, McDonald, G, Passaro, E, Phillips, L, Scamman, F, Spencer, J & Stremple, JF 1999, 'Relation of surgical volume to outcome in eight common operations: Results from the VA National Surgical Quality Improvement Program', Annals of Surgery, vol. 230, no. 3, pp. 414-432. https://doi.org/10.1097/00000658-199909000-00014
Khuri, Shukri F. ; Daley, Jennifer ; Henderson, William ; Hur, Kwan ; Hossain, Monir ; Soybel, David ; Kizer, Kenneth W ; Aust, J. Bradley ; Bell, Richard H. ; Chong, Vernon ; Demakis, John ; Fabri, Peter J. ; Gibbs, James O. ; Grover, Frederick ; Hammermeister, Karl ; McDonald, Gerald ; Passaro, Edward ; Phillips, Lloyd ; Scamman, Frank ; Spencer, Jeannette ; Stremple, John F. / Relation of surgical volume to outcome in eight common operations : Results from the VA National Surgical Quality Improvement Program. In: Annals of Surgery. 1999 ; Vol. 230, No. 3. pp. 414-432.
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abstract = "Objective: To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data: In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods: The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results: Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions: In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care.",
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T1 - Relation of surgical volume to outcome in eight common operations

T2 - Results from the VA National Surgical Quality Improvement Program

AU - Khuri, Shukri F.

AU - Daley, Jennifer

AU - Henderson, William

AU - Hur, Kwan

AU - Hossain, Monir

AU - Soybel, David

AU - Kizer, Kenneth W

AU - Aust, J. Bradley

AU - Bell, Richard H.

AU - Chong, Vernon

AU - Demakis, John

AU - Fabri, Peter J.

AU - Gibbs, James O.

AU - Grover, Frederick

AU - Hammermeister, Karl

AU - McDonald, Gerald

AU - Passaro, Edward

AU - Phillips, Lloyd

AU - Scamman, Frank

AU - Spencer, Jeannette

AU - Stremple, John F.

PY - 1999/9

Y1 - 1999/9

N2 - Objective: To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data: In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods: The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results: Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions: In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care.

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