Hospital volume is related to clinical and economic outcomes of esophagealresection in Maryland

Background. Previous studies have documented a relationship between hospita l volume and perioperative and economic outcomes. Our objective was to dete rmine the effect of hospital volume on outcomes of esophageal resection. Methods. Statewide database was analyzed for patients who underwent esophag eal resection in Maryland (n = 1,136 patients) from 1984 to 1999. Multivari ate regression was used to determine the association of hospital volume wit h in-hospital mortality, length of stay, and charges after adjusting for ca se mix and time period. Results. Unadjusted in-hospital mortality rates were lower in high volume h ospitals (2.7%) than medium (12.7%) and low (16%) volume hospitals (p < 0.0 01). High hospital volume was associated with (1) fivefold reduction in the risk of death (odds ratio, 0.21; 95% confidence interval, 0.10 to 0.42; p < 0.001); (2) a 6-day (95% confidence interval, 5 to 7 days; p < 0.001) red uction in length of stay; and (3) $11,673 (95% confidence interval, $9,504 to $12,841; p < 0.001) decrease in hospital charges. Conclusions. Hospitals that perform high volumes of esophageal resection ha ve superior clinical and economic outcomes. By referring these patients to high volume centers, we may improve quality and reduce costs. (C) 2001 by T he Society of Thoracic Surgeons.