Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery

Courtney J. Balentine, Aanand D. Naik, Celia N. Robinson, Nancy J. Petersen, G. John Chen, David H. Berger, Daniel A. Anaya

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

IMPORTANCE: Discharge disposition is a patient-centered qualitymetric that reflects differences in quality of life and recovery following surgery. The effect of hospital volume on quality of recovery measured by rates of successful discharge to home remains unclear. OBJECTIVE: To test the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than discharged to skilled rehabilitation facilities to complete recovery. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal analysis of 2008 hospital inpatient data to identify patients undergoing colorectal surgery who survived to discharge. The setting was the Nationwide Inpatient Sample, the largest all-payer inpatient care database, containing data from more than 1000 hospitals. Participants were 280 644 patients (≥18 years) who underwent colorectal resections for benign or malignant disease and survived to discharge. MAIN OUTCOMES AND MEASURES: The primary end pointwas discharge to home (with or without home health care) vs discharge to skilled facilities (skilled nursing, short-term recovery, or rehabilitation hospitals or other institutions). The secondary end point was discharge to home with home health care rather than to a skilled facility for patients with postdischarge care needs. Multiple logistic regression using robust standard errors was used to compute the odds ratios of each outcome based on hospital volume, while adjusting for other important variables. RESULTS: The odds of discharge to home vs discharge to skilled facilities were significantly greater in high-volume hospitals compared with low-volume hospitals (odds ratio, 2.09; 95% CI, 1.70-2.56), with an absolute increase of 9%. For patients with postdischarge care needs, high-volume hospitals were less likely than low-volume hospitals to use skilled facilities rather than home health care (odds ratio, 0.35; 95% CI, 0.27-0.45), with an absolute difference of 10%. CONCLUSIONS AND RELEVANCE: Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices.

Original languageEnglish (US)
Pages (from-to)244-251
Number of pages8
JournalJAMA Surgery
Volume149
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

Fingerprint

High-Volume Hospitals
Colorectal Surgery
Low-Volume Hospitals
Home Care Services
Inpatients
Odds Ratio
Delivery of Health Care
Rehabilitation
Skilled Nursing Facilities
Logistic Models
Quality of Life
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Balentine, C. J., Naik, A. D., Robinson, C. N., Petersen, N. J., Chen, G. J., Berger, D. H., & Anaya, D. A. (2014). Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery. JAMA Surgery, 149(3), 244-251. https://doi.org/10.1001/jamasurg.2013.3838

Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery. / Balentine, Courtney J.; Naik, Aanand D.; Robinson, Celia N.; Petersen, Nancy J.; Chen, G. John; Berger, David H.; Anaya, Daniel A.

In: JAMA Surgery, Vol. 149, No. 3, 01.03.2014, p. 244-251.

Research output: Contribution to journalArticle

Balentine, Courtney J. ; Naik, Aanand D. ; Robinson, Celia N. ; Petersen, Nancy J. ; Chen, G. John ; Berger, David H. ; Anaya, Daniel A. / Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery. In: JAMA Surgery. 2014 ; Vol. 149, No. 3. pp. 244-251.
@article{f90c797964aa4643897f9243bde2db35,
title = "Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery",
abstract = "IMPORTANCE: Discharge disposition is a patient-centered qualitymetric that reflects differences in quality of life and recovery following surgery. The effect of hospital volume on quality of recovery measured by rates of successful discharge to home remains unclear. OBJECTIVE: To test the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than discharged to skilled rehabilitation facilities to complete recovery. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal analysis of 2008 hospital inpatient data to identify patients undergoing colorectal surgery who survived to discharge. The setting was the Nationwide Inpatient Sample, the largest all-payer inpatient care database, containing data from more than 1000 hospitals. Participants were 280 644 patients (≥18 years) who underwent colorectal resections for benign or malignant disease and survived to discharge. MAIN OUTCOMES AND MEASURES: The primary end pointwas discharge to home (with or without home health care) vs discharge to skilled facilities (skilled nursing, short-term recovery, or rehabilitation hospitals or other institutions). The secondary end point was discharge to home with home health care rather than to a skilled facility for patients with postdischarge care needs. Multiple logistic regression using robust standard errors was used to compute the odds ratios of each outcome based on hospital volume, while adjusting for other important variables. RESULTS: The odds of discharge to home vs discharge to skilled facilities were significantly greater in high-volume hospitals compared with low-volume hospitals (odds ratio, 2.09; 95{\%} CI, 1.70-2.56), with an absolute increase of 9{\%}. For patients with postdischarge care needs, high-volume hospitals were less likely than low-volume hospitals to use skilled facilities rather than home health care (odds ratio, 0.35; 95{\%} CI, 0.27-0.45), with an absolute difference of 10{\%}. CONCLUSIONS AND RELEVANCE: Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices.",
author = "Balentine, {Courtney J.} and Naik, {Aanand D.} and Robinson, {Celia N.} and Petersen, {Nancy J.} and Chen, {G. John} and Berger, {David H.} and Anaya, {Daniel A.}",
year = "2014",
month = "3",
day = "1",
doi = "10.1001/jamasurg.2013.3838",
language = "English (US)",
volume = "149",
pages = "244--251",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery

AU - Balentine, Courtney J.

AU - Naik, Aanand D.

AU - Robinson, Celia N.

AU - Petersen, Nancy J.

AU - Chen, G. John

AU - Berger, David H.

AU - Anaya, Daniel A.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - IMPORTANCE: Discharge disposition is a patient-centered qualitymetric that reflects differences in quality of life and recovery following surgery. The effect of hospital volume on quality of recovery measured by rates of successful discharge to home remains unclear. OBJECTIVE: To test the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than discharged to skilled rehabilitation facilities to complete recovery. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal analysis of 2008 hospital inpatient data to identify patients undergoing colorectal surgery who survived to discharge. The setting was the Nationwide Inpatient Sample, the largest all-payer inpatient care database, containing data from more than 1000 hospitals. Participants were 280 644 patients (≥18 years) who underwent colorectal resections for benign or malignant disease and survived to discharge. MAIN OUTCOMES AND MEASURES: The primary end pointwas discharge to home (with or without home health care) vs discharge to skilled facilities (skilled nursing, short-term recovery, or rehabilitation hospitals or other institutions). The secondary end point was discharge to home with home health care rather than to a skilled facility for patients with postdischarge care needs. Multiple logistic regression using robust standard errors was used to compute the odds ratios of each outcome based on hospital volume, while adjusting for other important variables. RESULTS: The odds of discharge to home vs discharge to skilled facilities were significantly greater in high-volume hospitals compared with low-volume hospitals (odds ratio, 2.09; 95% CI, 1.70-2.56), with an absolute increase of 9%. For patients with postdischarge care needs, high-volume hospitals were less likely than low-volume hospitals to use skilled facilities rather than home health care (odds ratio, 0.35; 95% CI, 0.27-0.45), with an absolute difference of 10%. CONCLUSIONS AND RELEVANCE: Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices.

AB - IMPORTANCE: Discharge disposition is a patient-centered qualitymetric that reflects differences in quality of life and recovery following surgery. The effect of hospital volume on quality of recovery measured by rates of successful discharge to home remains unclear. OBJECTIVE: To test the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than discharged to skilled rehabilitation facilities to complete recovery. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal analysis of 2008 hospital inpatient data to identify patients undergoing colorectal surgery who survived to discharge. The setting was the Nationwide Inpatient Sample, the largest all-payer inpatient care database, containing data from more than 1000 hospitals. Participants were 280 644 patients (≥18 years) who underwent colorectal resections for benign or malignant disease and survived to discharge. MAIN OUTCOMES AND MEASURES: The primary end pointwas discharge to home (with or without home health care) vs discharge to skilled facilities (skilled nursing, short-term recovery, or rehabilitation hospitals or other institutions). The secondary end point was discharge to home with home health care rather than to a skilled facility for patients with postdischarge care needs. Multiple logistic regression using robust standard errors was used to compute the odds ratios of each outcome based on hospital volume, while adjusting for other important variables. RESULTS: The odds of discharge to home vs discharge to skilled facilities were significantly greater in high-volume hospitals compared with low-volume hospitals (odds ratio, 2.09; 95% CI, 1.70-2.56), with an absolute increase of 9%. For patients with postdischarge care needs, high-volume hospitals were less likely than low-volume hospitals to use skilled facilities rather than home health care (odds ratio, 0.35; 95% CI, 0.27-0.45), with an absolute difference of 10%. CONCLUSIONS AND RELEVANCE: Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices.

UR - http://www.scopus.com/inward/record.url?scp=84897901544&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897901544&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2013.3838

DO - 10.1001/jamasurg.2013.3838

M3 - Article

C2 - 24430092

AN - SCOPUS:84897901544

VL - 149

SP - 244

EP - 251

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 3

ER -