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Surgical Endoscopy

Published in:

01-10-2017

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Authors: Matthew D. Whealon, Juan J. Blondet, John V. Gahagan, Michael J. Phelan, Ninh T. Nguyen

Published in: Surgical Endoscopy | Issue 10/2017

Abstract

Background

There is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals.

Materials and methods

We reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume.

Results

A total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48–15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38–10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39–10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81–0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12–0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02).

Conclusions

There was a small but significant inverse relationship between the hospitals’ case volume and mortality in laparoscopic diaphragmatic hernia repair.

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Title: Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair
Authors: Matthew D. Whealon
Juan J. Blondet
John V. Gahagan
Michael J. Phelan
Ninh T. Nguyen
Publication date: 01-10-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5482-4

At a glance: The STEP trials

Springer Medicine

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Abstract

Background

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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