Anne M. Stey

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

BACKGROUND AND OBJECTIVES: Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically. Our goal was to compare total in-hospital cost and mortality by using propensity score–matched infants treated with peritoneal drainage alone, peritoneal drainage followed by laparotomy, or laparotomy alone for surgical NEC. METHODS: Utilizing the California OSHPD Linked Birth File Dataset, 1375 infants with surgical NEC between 1999 and 2007 were retrospectively propensity score matched according to intervention type. Total in-hospital costs were converted from longitudinal patient charges. A multivariate mixed effects model compared adjusted costs and mortality between groups. RESULTS: Successful propensity score matching was performed with 699 infants (peritoneal drainage, n = 101; peritoneal drainage followed by laparotomy, n = 172; and laparotomy, n = 426). Average adjusted cost for peritoneal drainage followed by laparotomy was

Extending the value of the National Surgical Quality Improvement Program claims dataset to study long-term outcomes: Rate of repeat ventral hernia repair

398 173 (95% confidence interval [CI]: 287 784–550 907), which was more than for peritoneal drainage (

Measuring risk-adjusted value using Medicare and ACS-NSQIP: is high-quality, low-cost surgical care achievable everywhere?

276 076 [95% CI: 196 238–388 394]; P = .004) and similar to laparotomy (

Are Procedures Codes in Claims Data a Reliable Indicator of Intraoperative Splenic Injury Compared with Clinical Registry Data

341 911 [95% CI: 251 304–465 186]; P = .08). Adjusted mortality was highest after peritoneal drainage (56% [95% CI: 34–75]) versus peritoneal drainage followed by laparotomy (35% [95% CI: 19–56]; P = .01) and laparotomy (29% [95% CI: 19–56]; P < .001). Mortality for peritoneal drainage was similar to laparotomy. CONCLUSIONS: Propensity score–matched analysis of surgical NEC treatment found that peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs.

Cost-utility analysis of repair of reducible ventral hernia

BACKGROUND Existing large clinical registries capture short-term follow-up. Yet, there are many important long-term outcomes in surgery, such as recurrence of a ventral hernia after ventral hernia repair. The goal of the current study was to conduct an exploratory analysis to determine whether the rates, timing, and risk factors for ventral hernia re-repair in claims data linked to registry data were consistent with the known clinical literature. STUDY DESIGN The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Medicare inpatient claims linked data set from 2005 to 2008 was queried to identify ventral hernia re-repairs after index ventral hernia repairs. Survival analysis was used to examine the ventral hernia re-repair rate over time and to quantify the relationship with clinical variables. RESULTS Of 3,730 index ventral hernia repairs identified in ACS-NSQIP, 247 patients (6.6%) underwent re-repair of a ventral hernia during the study period (2005-2008) in the Medicare claims data. ACS-NSQIP clinical variables that were associated with the ventral hernia re-repair rate in Medicare claims data 1 year after index ventral hernia repair were being a smoker (hazard ratio [HR] = 1.70, P = .02), body mass index (HR = 1.16, P = .04), and postoperative superficial surgical-site infection (HR = 2.88, P < .001). CONCLUSION Long-term rate and timing of ventral hernia re-repair obtained from claims data were an underestimate compared with clinical studies. Yet, several known clinical risk factors for recurrence in the clinical registry were associated with the re-repair rate in claims data at one year. It may be possible to study certain long-term outcomes using selected reoperation rates using the technique of linked clinical registry-claims data, with an understanding that event rates are conservative estimates.

Focusing quality improvement initiatives in pediatric plastic surgery-A descriptive study using the pediatric national surgical quality improvement program

Objective:To evaluate the relationship between risk-adjusted cost and quality for colectomy procedures and to identify characteristics of “high value” hospitals (high quality, low cost). Background:Policymakers are currently focused on rewarding high-value health care. Hospitals will increasingly be held accountable for both quality and cost. Methods:Records (2005–2008) for all patients undergoing colectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Cost was derived from hospital payments by Medicare. Quality was derived from the occurrence of 30-day postoperative major complications and/or death as recorded in ACS-NSQIP. Risk-adjusted cost and quality metrics were developed using hierarchical multivariable modeling, consistent with a National Quality Forum–endorsed colectomy measure. Results:The study population included 14,745 colectomy patients in 169 hospitals. Average hospitalization cost was

Is There Hospital Variation in Long-Term Incisional Hernia Repair after Abdominal Surgery?

21,350 (SD

Hospital variation in rates of concurrent fundoplication during gastrostomy enteral access procedures

20,773, median

Identification of Opportunities for Quality Improvement and Outcome Measurement in Pediatric Otolaryngology

16,092, interquartile range

Clinical registries and quality measurement in surgery: a systematic review.

14,341–