Skip to main content
Journal cover image

Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.

Publication ,  Conference
Chang, AL; Kim, Y; Ertel, AE; Hoehn, RS; Wima, K; Abbott, DE; Shah, SA
Published in: Surgery
May 2017

BACKGROUND: Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. METHODS: All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied. Patient and procedure details were used to generate a case mix-adjusted predictive model of total direct costs. Observed to expected costs for each center were evaluated between centers based on overall procedure volume. RESULTS: Patient and procedure characteristics were significantly different between volume tertiles. Observed costs at high-volume centers were less than at middle- and low-volume centers. According to our predictive model, high-volume centers cared for a less expensive case mix than middle- and low-volume centers ($12,786 vs $13,236 and $14,497, P < .01). Our predictive model accounted for 44% of the variation in costs. Overall efficiency (standardized observed to expected costs) was greatest at high-volume centers compared to middle- and low-volume tertiles (z score -0.16 vs 0.02 and -0.07, P < .01). CONCLUSION: Hospital costs and cost efficiency after an elective colectomy varies significantly between centers and may be attributed partially to the patient differences at those centers. These data demonstrate that a significant proportion of the cost variation is due to a distinct case mix at low-volume centers, which may lead to perceived poor performance at these centers.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

May 2017

Volume

161

Issue

5

Start / End Page

1405 / 1413

Location

United States

Related Subject Headings

  • United States
  • Surgery
  • Middle Aged
  • Male
  • Humans
  • Hospitals, Low-Volume
  • Hospitals, High-Volume
  • Hospital Costs
  • Female
  • Diagnosis-Related Groups
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chang, A. L., Kim, Y., Ertel, A. E., Hoehn, R. S., Wima, K., Abbott, D. E., & Shah, S. A. (2017). Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers. Surgery, 161(5), 1405–1413. https://doi.org/10.1016/j.surg.2016.10.019
Chang, Alex L., Young Kim, Audrey E. Ertel, Richard S. Hoehn, Koffi Wima, Daniel E. Abbott, and Shimul A. Shah. “Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.Surgery 161, no. 5 (May 2017): 1405–13. https://doi.org/10.1016/j.surg.2016.10.019.
Chang AL, Kim Y, Ertel AE, Hoehn RS, Wima K, Abbott DE, et al. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers. Surgery. 2017 May;161(5):1405–13.
Chang, Alex L., et al. “Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.Surgery, vol. 161, no. 5, May 2017, pp. 1405–13. Pubmed, doi:10.1016/j.surg.2016.10.019.
Chang AL, Kim Y, Ertel AE, Hoehn RS, Wima K, Abbott DE, Shah SA. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers. Surgery. 2017 May;161(5):1405–1413.
Journal cover image

Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

May 2017

Volume

161

Issue

5

Start / End Page

1405 / 1413

Location

United States

Related Subject Headings

  • United States
  • Surgery
  • Middle Aged
  • Male
  • Humans
  • Hospitals, Low-Volume
  • Hospitals, High-Volume
  • Hospital Costs
  • Female
  • Diagnosis-Related Groups