Dr Shyam Varadarajulu and colleagues evaluated the relationship between hospital procedure volume and outcome for various specialties and procedures.
Although increasingly used, to date, data on the relationship between hospital volume and outcome of endoscopic retrograde cholangiopancreatography (ERCP) are scant.
The team sought to examine health-related outcomes after ERCP in relation to hospital procedure volume.
Secondary analysis of a national administrative database.
The team accessed the National Inpatient Sample database to evaluate health-related outcomes from 1998 to 2001.
|25% of hospitals performed 100 ERCP procedures per year|
Logistic and multiple regression models were used to estimate the association of hospital ERCP with length of stay, rates of procedural failure, and mortality.
Fixed effect models were used to adjust for all time invariant hospital characteristics for each hospital within the dataset.
The researchers evaluated data from 2629 hospitals that performed 199,625 ERCP procedures.
The research team found that the median number of ERCP procedures performed in participating hospitals was 49 per year.
The team noted that 25% of hospitals performed 100 ERCP procedures per year and 5% performing 200 per year.
Significant trends in the relationship between volume and outcome were observed with respect to length of stay and procedural failure.
The team observed that the median length of stay was lower in high-volume than low-volume hospitals.
The mean difference in expected length of stay was 1 day.
Multivariate regressions with hospital level fixed effects found significant negative relationships between procedure volume and procedure failure rates.
However, the researchers detected no significant effect on inpatient mortality rates.
The team reported that the National Inpatient Sample database permits analyses of only inpatient ERCPs.
Use of the database precludes analysis of procedural complications, reinterventions, and influence of individual provider volume on outcomes.
Dr Varadarajulu's team concluded, “Inpatients who undergo ERCP at high-volume hospitals have shorter length of stay and lower procedural failure rates than those undergoing ERCP at low-volume hospitals.”
“These findings have important implications for health care policy decision making and resource utilization.”