PMID- 25239333
OWN - NLM
STAT- MEDLINE
DCOM- 20141113
LR  - 20220317
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 156
IP  - 4
DP  - 2014 Oct
TI  - A variation in the value of colectomy for cancer across hospitals: mortality, 
      readmissions, and costs.
PG  - 849-56, 860
LID - S0039-6060(14)00329-8 [pii]
LID - 10.1016/j.surg.2014.06.011 [doi]
AB  - INTRODUCTION: Although hospital variation in costs and outcomes has been 
      described for patients undergoing operation, the relationship between them is 
      unknown. The purpose of this study was to evaluate this relationship among 
      patients undergoing colon resection for cancer and identify characteristics of 
      "high-quality, low-cost" hospitals. METHODS: We identified adult patients who 
      underwent colon resection for cancer in California, Florida, and New York from 
      2009 to 2010. We estimated hospital-level, risk-standardized 30-day hospital 
      costs, in-hospital mortality rates, and 30-day readmission rates by using 
      hierarchical generalized linear models. Costs were compared between hospitals 
      identified as low, average, and high performers. RESULTS: The final sample 
      included 14,790 patients discharged from 389 hospitals. After adjusting for case 
      mix, variation was noted in risk-standardized costs (median = $26,169, 
      inter-quartile range [IQR] = $6,559), in-hospital mortality (median = 1.8%, 
      IQR = 2.3%), and 30-day readmission (12.2%, IQR = 0.7%) rates. Minimal 
      correlation was noted between a hospital's costs and outcomes, with similar costs 
      noted across hospital performance groups (low = $25,994 vs average = $26,998 vs 
      high = $25,794, P = .19). High-quality, low-cost hospitals treated a greater 
      percentage of Medicare beneficiaries, approached fewer cases laparoscopically, 
      and trended toward greater volume. CONCLUSION: Hospital costs are not correlated 
      with outcomes in this population. More work is needed to identify means of 
      providing high-quality care at lesser costs.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Fox, Justin P
AU  - Fox JP
AD  - Department of Surgery, Boonshoft School of Medicine, Wright State University, 
      Dayton, OH. Electronic address: justin_p_fox@yahoo.com.
FAU - Tyler, Joshua A
AU  - Tyler JA
AD  - Section of Colon and Rectal Surgery, Division of General Surgery, Washington 
      University School of Medicine, St. Louis, MO.
FAU - Vashi, Anita A
AU  - Vashi AA
AD  - VA Palo Alto Healthcare System, Palo Alto, CA.
FAU - Hsia, Renee Y
AU  - Hsia RY
AD  - Department of Emergency Medicine, University of California San Francisco, San 
      Francisco, CA.
FAU - Saxe, Jonathan M
AU  - Saxe JM
AD  - Department of Surgery, Boonshoft School of Medicine, Wright State University, 
      Dayton, OH.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
CIN - Surgery. 2014 Oct;156(4):856-9. PMID: 25239334
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - California
MH  - Cohort Studies
MH  - Colectomy/*economics/mortality
MH  - Colonic Neoplasms/economics/mortality/*surgery
MH  - Female
MH  - Florida
MH  - Hospital Costs/*statistics & numerical data
MH  - *Hospital Mortality
MH  - Humans
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - New York
MH  - Outcome Assessment, Health Care
MH  - Patient Readmission/economics/*statistics & numerical data
MH  - Quality Indicators, Health Care
MH  - Retrospective Studies
MH  - Risk Adjustment
MH  - Young Adult
EDAT- 2014/09/23 06:00
MHDA- 2014/11/14 06:00
CRDT- 2014/09/21 06:00
PHST- 2014/01/29 00:00 [received]
PHST- 2014/06/18 00:00 [accepted]
PHST- 2014/09/21 06:00 [entrez]
PHST- 2014/09/23 06:00 [pubmed]
PHST- 2014/11/14 06:00 [medline]
AID - S0039-6060(14)00329-8 [pii]
AID - 10.1016/j.surg.2014.06.011 [doi]
PST - ppublish
SO  - Surgery. 2014 Oct;156(4):849-56, 860. doi: 10.1016/j.surg.2014.06.011.