PMID- 31203075
OWN - NLM
STAT- MEDLINE
DCOM- 20200122
LR  - 20200122
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 129
DP  - 2019 Sep
TI  - Volume-Cost Relationship in Neurosurgery: Analysis of 12,129,029 Admissions from 
      the National Inpatient Sample.
PG  - e791-e802
LID - S1878-8750(19)31575-X [pii]
LID - 10.1016/j.wneu.2019.06.034 [doi]
AB  - BACKGROUND/OBJECTIVE: Several studies have documented improved outcomes at 
      high-volume hospitals for neurosurgery. However, the relationship between 
      neurosurgical volume and costs remains poorly understood. METHODS: Using 
      neurosurgery-specific Diagnosis-Related Groups (DRG) codes, we identified adult 
      neurosurgical admissions in the National Inpatient Sample from 2002 to 2014. We 
      stratified hospitals by annual neurosurgical volume as high-volume (top 20%) or 
      low-volume centers (bottom 80%). We performed survey-weighted regression analyses 
      to examine the impact of case volume on inpatient costs. RESULTS: A total of 
      12,129,029 admissions underwent neurosurgery from 2002 to 2014, with 59.6% 
      treated at high-volume hospitals. Patients at high-volume centers were more 
      likely to have private insurance, higher risk of mortality scores, and higher DRG 
      weight procedures than those at low-volume centers (P < 0.001). High-volume 
      hospital admissions were on average 9% or $1791 more expensive than their 
      low-volume counterparts. However, after adjustment for patient, hospital, and 
      case-mix differences, high-volume hospitals were 4.3% less expensive than 
      low-volume centers ($21,825 vs. $22,924; P < 0.01). The southern United States, 
      which had the biggest volume, showed the highest savings (6.5%). CONCLUSIONS: 
      High-volume hospitals provide more cost-effective neurosurgical care. 
      Centralization of care at high-volume neurosurgical institutions may be a 
      promising strategy to delivering higher-value care, achieving better outcomes at 
      lower costs.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Yoon, James S
AU  - Yoon JS
AD  - Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's 
      Hospital and Medical Center, Phoenix, Arizona, USA; Yale School of Medicine, New 
      Haven, Connecticut, USA.
FAU - Tang, Oliver Y
AU  - Tang OY
AD  - Brown University, Providence, Rhode Island, USA.
FAU - Lawton, Michael T
AU  - Lawton MT
AD  - Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's 
      Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: 
      michael.lawton@barrowbrainandspine.com.
LA  - eng
PT  - Journal Article
DEP - 20190614
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
SB  - IM
MH  - Hospitalization/*economics
MH  - *Hospitals, High-Volume
MH  - Humans
MH  - Inpatients
MH  - Length of Stay/economics
MH  - Neurosurgical Procedures/*economics
MH  - United States
OTO - NOTNLM
OT  - Centralization of surgery
OT  - Health care economics
OT  - Value-based health care
OT  - Volume-cost
EDAT- 2019/06/17 06:00
MHDA- 2020/01/23 06:00
CRDT- 2019/06/17 06:00
PHST- 2019/02/25 00:00 [received]
PHST- 2019/06/03 00:00 [revised]
PHST- 2019/06/03 00:00 [accepted]
PHST- 2019/06/17 06:00 [pubmed]
PHST- 2020/01/23 06:00 [medline]
PHST- 2019/06/17 06:00 [entrez]
AID - S1878-8750(19)31575-X [pii]
AID - 10.1016/j.wneu.2019.06.034 [doi]
PST - ppublish
SO  - World Neurosurg. 2019 Sep;129:e791-e802. doi: 10.1016/j.wneu.2019.06.034. Epub 
      2019 Jun 14.