Faculty Collaboration Database

Variable surgical outcomes after hospital consolidation: Implications for local health care delivery. Surgery 2016 Nov;160(5):1155-1161

Date

10/30/2016

Pubmed ID

27425041

Pubmed Central ID

PMC5124379

DOI

10.1016/j.surg.2016.05.027

Scopus ID

2-s2.0-84978829954 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: With more hospital consolidations as an inevitable part of our future health care ecosystem, we investigated the relationship between hospital consolidations and operative outcomes.

METHODS: Using the Health Care Cost and Utilization Project State Inpatient Database (Florida and California), the American Hospital Association Annual Survey Database, and Medicare's Case Mix Index data, we identified 19 hospitals that consolidated between 2007 and 2013 and propensity matched them with 19 independent hospitals, using patient and hospital characteristics. One year before consolidation and again 1 year after, we used difference-in-differences analysis to compare changes in the risk-adjusted complication rate of 7 elective operations performed in the consolidated hospitals and in the matched control group.

RESULTS: Of the 7 procedures studied, 2 procedures saw a decrease in complication rate (lumbar and lumbosacral fusion of the posterior column posterior technique, difference-in-differences = -0.6%, P < .01; total hip replacement, difference-in-differences = -0.6%, P < .01); 3 procedures saw an increase in complication rate (transurethral prostatectomy, difference-in-differences = 4.1%, P < .01; cervical fusion of the anterior column anterior technique, difference-in-differences = 1.5%, P < .01; total knee replacement, difference-in-differences = 0.3%, P < .01); and 2 procedures saw no change in complication rate (laparoscopic cholecystectomy, lumbar and lumbosacral fusion of the anterior column posterior technique, both P > .05) after hospital consolidation.

CONCLUSION: Arguments have been made that consolidated health care systems can share high-performing clinical services and infrastructure resources, such as electronic medical records, to improve quality. Our results indicate that hospital consolidation does not uniformly improve postoperative complication rates.

Author List

Chang V, Blackwell RH, Yau RM, Besser S, Albright JM, Gupta GN, Kuo PC, Kothari AN

Author

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Databases, Factual
Delivery of Health Care
Female
Health Care Reform
Hospitals
Humans
Male
Middle Aged
Organizational Innovation
Postoperative Complications
Retrospective Studies
Surgical Procedures, Operative
United States