A. B. Pratt1, S. Gale1, V. Y. Dombrovskiy1, M. E. Lissauer1 1Robert Wood Johnson – UMDNJ,Acute Care Surgery,New Brunswick, NJ, USA
Introduction: Though controversial, volume may be related to quality in elective surgery. Elderly emergency general surgery patients(EGSP) have not been studied in this manner. Our goal was to compare EGSP outcomes in high volume (HVH) and low volume (LVH) hospitals.
Methods: Nationwide Inpatient Sample 2012-2013 was queried for EGSP hospitalizations and were ranked by annual EGSP volume. EGSP were identified by ICD code. Top 10% of hospitals were classified as HVH. Complications, mortality, length of stay (LOS) and cost were compared by Chi-square test, multivariable analysis and Wilcoxon rank sum test.
Results: HVH represented 10% of hospitals and 29.7% of EGSP hospitalizations. In both HVH and LVH ≈ 30 % of EGSP underwent surgery. EGSP in HVH were older (77.7±7.9 years vs 77.5±7.9; P <. 0001), more likely Caucasian (78.3% vs 72.6%; P<.0001), and more likely to be male (HVH=57.6%, LVH=57.0%; P<.0001). In Chi-square analysis, HVH demonstrated more complications (45.3% vs LV 44.2%; P <. 0001), including cardiac (2.3% vs 2.2; P =. 003), respiratory (3.7% vs 3.34%; P <.0001), and renal (16.2% vs 16.0%; P <.0001) but fewer infections (17.8% vs 18.4%; P <.0001). Mortality was greater in HVH (2.8% vs 2.6%; P=.0002). However, in multivariable logistic regression analysis adjusting for patient age, gender, race, comorbidities, complications, EGS area, and need for surgery, differences in mortality disappeared. Mortality in both groups was still greater if patient had surgery. LOS was greater in HVH (HVH 5.7 days vs LVH 5.3; P<.0001) but total hospital cost was lower ($11432 vs $11509; P <. 0001).
Conclusion: There is no mortality difference in HVH compared to LVH treating EGSP. LOS is greater in HVH, and patients may have more complications. Cost is statistically lower in HVH despite longer LOS.