Effects of hospital volume on life expectancy after selected XXXX operations in older adults: a decision analysis.

@entity1 @entity788 @entity5 @entity2 @entity694
BACKGROUND: In addition to lower operative mortality, @entity1 undergoing selected @entity5 operations at high volume centers have improved longterm survival. We sought to determine the overall effect of hospital volume on life expectancy after @entity5 surgery. STUDY DESIGN: We used a Markov decision analysis model to estimate life expectancy for @entity1 undergoing resection for @entity694 . Model inputs included probabilities of operative mortality and longterm survival. For input data, we examined operative mortality (in-hospital or within 30 days) stratified by volume in over 400,000 @entity1 undergoing resection for these three @entity5 using the national Medicare database (1994-1999). Risks of late mortality were abstracted from published studies (MEDLINE, 1966 to present) to model the effect of hospital volume on longterm survival. In analysis, we first calculated life expectancy for @entity1 undergoing surgery at very low, low, medium, high, and very high volume hospitals. We then explored the effects of various regionalization strategies. RESULTS: Life expectancy increased steadily with hospital volume for all three @entity5 . Life expectancy after @entity788 resection increased linearly with hospital volume: from 1.9 years at very low volume centers to 3.6 years at very high volume centers. For @entity2 , life expectancy ranged from 5.4 to 6.6 years. Increases in life expectancy for @entity694 were not as dramatic: from 6.8 at very low volume hospitals to 7.4 years at very high volume hospitals. Differences in life expectancy across volume strata were largely attributable to differences in longterm survival, not operative mortality. From a policy perspective, regionalizing surgery for @entity694 would produce the greatest overall life-expectancy gains, but it would require moving most @entity1 . CONCLUSIONS: @entity1 aged 65 and older with pancreatic, lung, and @entity694 have substantially greater life expectancy after @entity5 resection at higher volume hospitals. Further work is needed to understand the mechanisms underlying differences in performance across hospitals in @entity5 care.
