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- W4239601381 abstract "Abstract Background The more frequent a hospital performs a procedure, the better the outcome of the procedure; however, the mechanisms of this volume-outcome relationship have not been deeply elucidated to date. We aimed to determine whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. Methods We included all patients who underwent one of ten digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Learning effect was investigated by considering the interaction between hospital groups and procedure year. Results Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients’ mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). Conclusions Trend in hospital volume over time does not appear to influence patient outcomes, which puts the relevance of the practice-makes-perfect dogma in question." @default.
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- W4239601381 date "2019-12-02" @default.
- W4239601381 modified "2023-09-24" @default.
- W4239601381 title "Influence of trends in hospital volume over time on patient outcomes for high-risk surgery" @default.
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- W4239601381 doi "https://doi.org/10.21203/rs.2.17868/v1" @default.
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