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Published in:

01-11-2015

Variation of outcome and charges in operative management for diverticulitis

Authors: Hans F. Fuchs, Ryan C. Broderick, Cristina R. Harnsberger, David C. Chang, Elisabeth C. Mclemore, Sonia Ramamoorthy, Santiago Horgan

Published in: Surgical Endoscopy | Issue 11/2015

Abstract

Background

Outcomes after surgery for diverticulitis are of continued interest to improve quality of care. The aim of this study was to assess variations in mortality, length of stay, and patient charges between geographic regions of the United States.

Methods

A retrospective analysis of the Nationwide Inpatient Sample database was performed. Adults with diverticulitis who underwent laparoscopic or open segmental colectomy were identified using ICD-9 codes. Subset analyses were performed by state and then compared. Outcomes included mortality, length of stay (LOS), and total charges. Results were adjusted for age, race, gender, findings of peritonitis, stoma placement, Charlson comorbidity index, and insurance status on multivariate analysis.

Results

148,874 patients underwent segmental colectomy for diverticulitis from 1998 to 2010. Using California as the comparison state and after adjusting for covariates, in-hospital mortality was significantly higher in the State of New York (OR 1.32; 95 % CI 1.13–1.55; P < 0.05) and Mississippi (OR 2.84; 95 % CI 1.24–6.51, P < 0.02). Wisconsin had a significant lower mortality rate (OR 0.74; 95 % CI 0.59–0.94, P < 0.01). LOS was 1.4 days longer in New York and 0.54 days shorter in Wisconsin than in California (P < 0.01). Patients with age >40 years, findings of peritonitis, and without private insurance had higher in-hospital mortality and longer length of stay. Average hospital charges differed dramatically between the states in the observation period. The highest hospital charges occurred in California, Nebraska, and Nevada while lowest occurred in Maryland, Wisconsin and Utah.

Conclusions

Patients who undergo surgical treatment for diverticulitis in the United States have high geographic variation in mortality, LOS, and hospital charges despite adjusting for demographic and socioeconomic factors. Further analysis should be performed to identify the causes of outlier regions, with the goal of improving and standardizing best practices.

Van Arendonk KJ, Tymitz KM, Gearhart SL, Stem M, Lidor AO (2013) Outcomes and costs of elective surgery for diverticular disease: a comparison with other diseases requiring colectomy. JAMA Surg 148(4):316–321CrossRefPubMed

Etzioni DA, Mack TM, Beart RW Jr., Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217CrossRefPubMed

Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122:1500–1511CrossRefPubMed

Ricciardi R, Roberts PL, Read TE, Marcello PW, Hall JF, Schoetz DJ, Foley EF (2011) Cyclical increase in diverticulitis during the summer months. Arch Surg 146(3):319–323CrossRefPubMed

Laurell H, Hansson LE, Gunnarson U (2007) Acute diverticulitis—clinical presentation and differential diagnosis. Colorectal Dis 9:496–502CrossRefPubMed

Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338(21):1521–1526 ReviewCrossRefPubMed

Davis AE, Mehrotra S, McElroy LM, Friedewald JJ, Skaro AI, Lapin B, Kang R, Holl JL, Abecassis MM, Ladner DP (2014) The extent and predictors of waiting time geographic disparity in kidney transplantation in the United States. Transplantation 97(10):1049–1057CrossRefPubMed

Fitzgerald JD, Weng HH, Soohoo NF, Ettner SL (2013). Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery. J Hosp Adm. doi:10.5430/jha.v2n4p71

Sømme S, Bronsert M, Morrato E, Ziegler M (2013) Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 132(6):e1466–e1472CrossRefPubMed

10.

Hyder O, Dodson RM, Nathan H, Herman JM, Cosgrove D, Kamel I, Geschwind JF, Pawlik TM (2013) Referral patterns and treatment choices for patients with hepatocellular carcinoma: a United States population-based study. J Am Coll Surg 217(5):896–906PubMedCentralCrossRefPubMed

11.

Matlock DD, Groeneveld PW, Sidney S, Shetterly S, Goodrich G, Glenn K, Xu S, Yang L, Farmer SA, Reynolds K, Cassidy-Bushrow AE, Lieu T, Boudreau DM, Greenlee RT, Tom J, Vupputuri S, Adams KF, Smith DH, Gunter MJ, Go AS, Magid DJ (2013) Geographic variation in cardiovascular procedure use among Medicare fee-for-service vs Medicare Advantage beneficiaries. JAMA 310(2):155–162PubMedCentralCrossRefPubMed

12.

Eastwood MA, Sanderson J, Pocock SJ, Mitchell WD (1977) Variation in the incidence of diverticular disease within the city of Edinburgh. Gut 18(7):571–574PubMedCentralCrossRefPubMed

13.

Tridente A, Clarke GM, Walden A, McKechnie S, Hutton P, Mills GH, Gordon AC, Holloway PA, Chiche JD, Bion J, Stuber F, Garrard C, Hinds CJ, GenOSept Investigators (2014) Patients with faecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Intensive Care Med 40(2):202–210CrossRefPubMed

14.

van Gijn W, van de Velde CJ (2011) 2010 SSO John Wayne clinical research lecture: rectal cancer outcome improvements in Europe: population-based outcome registrations will conquer the world. Ann Surg Oncol 18(3):691–696PubMedCentralCrossRefPubMed

15.

Burns EM, Bottle A, Aylin P, Darzi A, Nicholls RJ, Faiz O (2011) Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics. BMJ 16(343):d4836CrossRef

16.

Henneman D, van Bommel AC, Snijders A, Snijders HS, Tollenaar RA, Wouters MW, Fiocco M (2014) Ranking and rankability of hospital postoperative mortality rates in colorectal cancer surgery. Ann Surg 259(5):844–849CrossRefPubMed

17.

van de Velde CJ, Boelens PG, Borras JM, Coebergh JW, Cervantes A, Blomqvist L et al (2014) EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 50(1):1.e1–1.e34

18.

Breugom AJ, Boelens PG, van den Broek CB, Cervantes A, Van Cutsem E, Schmoll HJ, Valentini V, van de Velde CJ (2014) Quality assurance in the treatment of colorectal cancer: the EURECCA initiative. Ann Oncol 25(8):1485–1492CrossRefPubMed

19.

Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM (2005) Racial trends in the use of major procedures among the elderly. N Engl J Med 353(7):683–691CrossRefPubMed

20.

Agency for Healthcare Research and Quality (2007–2009) HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 24 Apr 2014

21.

Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619CrossRefPubMed

22.

Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109PubMed

23.

Lawson EH, Gibbons MM, Ko CY, Shekelle PG (2012) The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures. J Clin Epidemiol 65(11):1133–1143CrossRefPubMed

24.

Martin M, Beekley A, Kjorstad R, Sebesta J (2010) Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis 6(1):8–15CrossRefPubMed

25.

Nusrat S, Bielefeldt K (2014) Fundoplication for gastroesophageal reflux disease: regional variability and factors predicting operative approach. Dis Esophagus 27(8):719–725CrossRefPubMed

26.

Keyhani S, Falk R, Bishop T, Howell E, Korenstein D (2012) The relationship between geographic variations and overuse of healthcare services: a systematic review. Med Care 50(3):257–261CrossRefPubMed

27.

Patel MR (2012) Appropriate use criteria to reduce underuse and overuse: striking the right balance. J Am Coll Cardiol 60(19):1885–1887CrossRefPubMed

28.

Chassin MR (1998) Is health care ready for Six Sigma quality? Milbank Q 76(4):565–591PubMedCentralCrossRefPubMed

29.

Sobottka SB, Töpfer A, Eberlein-Gonska M, Schackert G, Albrecht DM (2010) Improvement of medical processes with Six Sigma—practicable zero-defect quality in preparation for surgery. Z Evid Fortbild Qual Gesundhwes 104(6):480–488CrossRefPubMed

30.

Cima RR, Brown MJ, Hebl JR, Moore R, Rogers JC, Kollengode A, Amstutz GJ, Weisbrod CA, Narr BJ, Deschamps C (2011) Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg 213(1):83–92 discussion 93–94CrossRefPubMed

31.

Klabunde CN, Warren JL, Legler JM (2002) Assessing comorbidity using claims data: an overview. Med Care 40(8 suppl):IV-26–IV-35

Title: Variation of outcome and charges in operative management for diverticulitis
Authors: Hans F. Fuchs
Ryan C. Broderick
Cristina R. Harnsberger
David C. Chang
Elisabeth C. Mclemore
Sonia Ramamoorthy
Santiago Horgan
Publication date: 01-11-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-4046-0

At a glance: The STEP trials

Springer Medicine

Variation of outcome and charges in operative management for diverticulitis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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