SSAT - Cost Effectiveness in Hepatic Lobectomy: the Volume Effect on Resource Utilization

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Cost Effectiveness in Hepatic Lobectomy: the Volume Effect on Resource Utilization
Richard Hoehn^*, Jeffrey M. Sutton, Audrey Ertel, Gregory C. Wilson, Dennis J. Hanseman, Koffi Wima, Jeffrey Sussman, Syed Ahmad, Shimul a. Shah, Daniel E. Abbott

Department of Surgery, Cincinnati Research in Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, OH

OBJECTIVE: Higher-volume centers demonstrate superior perioperative outcomes for complex surgical interventions, though resource utilization implications of this hospital-level variation are unclear. We hypothesized that for hepatic lobectomy, higher operative volume correlates with improved outcomes and lower costs.
METHODS: 4,163 patients undergoing hepatic lobectomy from 2009-2011 were identified from the University HealthSystems Consortium database. Univariate, multivariate logistic regression, and decision analytic models were constructed to identify discrepancies in hospital utilization and cost. Cost included both index and readmission hospitalizations, when applicable.
RESULTS: The 30-day readmission rate for all patients was 13.4%. Hospitals performing >30 hepatic lobectomies per year had significantly lower readmission rates than those hospitals performing ≤15 lobectomies annually (10.6 vs. 16.0%, p<0.001). On multivariate analysis, higher severity of illness (OR 2.134, 95% CI [1.48-3.07], p<0.0001), discharge to rehab (OR 1.84, [1.28-2.64], p<0.001), home with home health care (OR 1.38, [1.08-1.76], p=0.01), and surgery at a low-volume hospital (OR 1.49, [1.18-1.88], p<0.001) were independent predictors of readmission. When both index and readmission costs were considered, per-patient cost was 21.9% higher at low-volume centers when compared to high-volume centers (\,669 vs. \,137). Sensitivity analyses adjusted for perioperative mortality (1.7%) and readmission (10.6%) at all centers did not significantly change the analysis; savings at higher-volume centers were 21% and 19.3% for these scenarios.
CONCLUSIONS: These data, for the first time, demonstrate that hospital volume in hepatic lobectomy is an important, modifiable risk factor for readmission and cost. To optimize resource utilization, patients undergoing complex hepatic surgery should be directed to more experienced hospital systems.

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