Variation in XXXX rates after high-risk surgery in the United States.

@entity1 @entity295 @entity260 @entity177 @entity281 @entity358 @entity299 @entity258 @entity1028 @entity1173
OBJECTIVE: Our goal was to characterize variation in complication rates across hospitals with differing volumes for select high-risk operations in the United States. METHODS: Data from the Nationwide Inpatient Sample for 1996 and 1997 were analyzed for 3 high-risk operations: esophagectomy (n=1,226), pancreatectomy (n=4,789), and intact @entity1028 repair (n=11,863). Complications evaluated included @entity1173 , @entity299 , @entity281 , @entity358 , @entity177 , @entity295 , and others. The risk of complications was calculated by hospital volume deciles, as well as for high-volume hospitals (HVH) and @entity258 ( @entity258 ) defined by median hospital volume. RESULTS: Rates of any @entity260 varied nearly 2-fold across hospital volume groups. The proportion of @entity1 across hospital deciles having at least one complication ranged from 30% to 51% for esophageal resection, 6% to 12% for pancreatic resection, and 9% to 18% for @entity1028 repair. HVH had lower rates of one or more complications after pancreatic resection (OR, 0.71; 95% CI, 0.57 to 0.83; P=.002), esophageal resection (OR, 0.68; 95% CI, 0.52 to 0.90; P=.008), and intact @entity1028 ( @entity1028 ) repair (OR, 0.67; 95% CI, 0.59 to 0.76; P<.001). @entity1 with one or more complications after pancreatic resection had a mortality of 18.8% versus only 5.2% for those without complications (P<.001). Esophageal resection mortality was 16.9% for @entity1 with at least one complication and 2.5% for those without complications (P<.001) and @entity1028 repair mortality was 10.4% for @entity1 with at least one complication and 2.9% for those without complications (P<.001). CONCLUSIONS: High-risk operations have a decreased rate of @entity260 when performed at HVH. Variation in complication rates may contribute to the volume-outcome relationship and provide a focus for quality improvement at @entity258 .
