In-hospital mortality and morbidity after surgical treatment of unruptured XXXX in the United States, 1996-2000: the effect of hospital and surgeon volume.

@entity1 @entity16 @entity439 @entity438
OBJECTIVE: We sought to determine the risk of adverse outcome after contemporary surgical treatment of @entity1 with unruptured @entity438 in the United States. @entity1 , surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care. METHODS: We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS: We identified 3498 @entity1 who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all @entity1 , 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of @entity439 treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer @entity439 : discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer @entity439 , but not significantly so. @entity1 treated by high-volume surgeons had fewer @entity16 (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer @entity439 . CONCLUSION: For @entity1 with @entity439 who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.
