Table 4.
Multivariable Analyses Assessing the Influence of Surgeon Volume on Outcomes
| Laparoscopy |
Complication |
Reoperation |
ICU admission |
LOS, d |
Cost, $ |
|
|---|---|---|---|---|---|---|
| Variable | Odds ratio (95% CI) | Beta coefficient (95% CI) | ||||
| Surgeon volume category | ||||||
|
| ||||||
| Low | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
|
| ||||||
| Medium | 1.16 (1.06, 1.26) | 0.89 (0.77, 1.03) | 0.77 (0.60, 0.98) | 0.89 (0.80, 1.00) | −0.05 (−0.34, 0.23) | −810 (−1,407, −213) |
|
| ||||||
| High | 1.27 (1.15, 1.39) | 0.77 (0.76, 0.91) | 0.70 (0.53, 0.92) | 0.98 (0.87, 1.10) | −0.01 (−0.31, 0.30) | −927 (−1,567, -287) |
|
| ||||||
| Hospital volume category | ||||||
|
| ||||||
| Low | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
|
| ||||||
| Medium | 1.62 (1.32, 2.00) | 1.53 (1.04, 2.27) | 1.09 (0.62, 1.94) | 0.85 (0.68, 1.05) | 0.48 (−0.17, 1.13) | 1,097 (−334, 2,528) |
|
| ||||||
| High | 1.89 (1.54, 2.31) | 1.61 (1.10, 2.35) | 1.02 (0.59, 1.79) | 0.67 (0.54, 0.83) | 0.39 (−0.21, 1.05) | 2657 (1,279, 4,036) |
|
| ||||||
| Very high | 2.02 (1.66, 2.47) | 1.67 (1.16, 2.43) | 0.96 (0.55, 1.66) | 0.44 (0.35, 0.54) | 0.18 (−.044, 0.79) | 1011 (−343, 2,367) |
|
| ||||||
| Age, per year increase | 1.01 (1.00, 1.01) | 0.99 (0.99, 1.00) | 0.99 (0.98, 1.00) | 1.01 (1.00, 1.01) | 0.00 (−0.01, 0.01) | −25 (−46, -3) |
|
| ||||||
| Female (vs male) | 1.08 (1.01, 1.14) | 0.68 (0.60, 0.76) | 0.72 (0.59, 0.87) | 0.84 (0.77, 0.91) | −0.53 (−0.74, −0.33) | −1,212 (−1,647, −778) |
|
| ||||||
| Race | ||||||
|
| ||||||
| White | Ref. | Ref. | – | Ref. | Ref. | Ref. |
|
| ||||||
| Black | 0.95 (0.87, 1.04) | 1.00 (0.85, 1.20) | – | 0.83 (0.73, 0.94) | 0.59 (0.29, 0.91) | 535 (−127, 1,197) |
|
| ||||||
| Other | 1.35 (1.23, 1.48) | 1.00 (0.85, 1.20) | – | 0.76 (0.68, 0.88) | 0.30 (−0.01, 0.60) | 38 (−613, 688) |
|
| ||||||
| Insurance status | ||||||
|
| ||||||
| Private | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
|
| ||||||
| Public | 0.82 (0.75, 0.89) | 1.52 (1.30, 1.78) | 1.16 (0.90, 1.49) | 1.32 (118, 1.48) | 0.58 (0.30, 0.86) | 705 (119, 1,292) |
|
| ||||||
| Other | 0.71 (0.60, 0.85) | 1.08 (0.77, 1.51) | 0.83 (0.48, 1.44) | 1.21 (0.97, 1.51) | −0.02 (−0.60, 0.55) | −637 (−1,858, 584) |
|
| ||||||
| High severity of illness (vs low) | 0.41 (0.37, 0.47) | 2.42 (2.08, 2.83) | 1.56 (1.20, 2.02) | 2.83 (2.51, 3.19) | 3.78 (3.40, 4.16) | 7,154 (6,357, 7,951) |
|
| ||||||
| Laparoscopic (vs open) | – | 0.57 (0.51, 0.66) | 0.91 (0.74, 1.12) | 0.44 (0.40, 0.48) | −2.12 (−2.33, −1.90) | −2,716 (−3,160, −2,273) |
|
| ||||||
| Procedure | ||||||
|
| ||||||
| Total colectomy | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
|
| ||||||
| Left colectomy | 1.32 (1.10, 1.58) | 0.92 (0.66, 1.25) | 0.57 (0.37, 0.88) | 0.85 (0.68, 1.05) | −1.44 (−2.02, −0.86) | −2,134 (−3,357, −912) |
|
| ||||||
| Right colectomy | 1.72 (1.47, 2.02) | 0.88 (0.67, 1.16) | 0.44 (0.30, 0.65) | 0.69 (0.58, 0.85) | −1.88 (−2.40, −1.35) | −3,739 (−4,832, −2,639) |
|
| ||||||
| Transverse colectomy | 0.94 (0.75, 1.17) | 0.79 (0.53, 1.16) | 0.52 (0.29, 0.94) | 0.73 (0.56, 0.95) | −1.56 (2.28, −0.83) | −3608 (−5,124, −2,092) |
|
| ||||||
| Sigmoid colectomy | 1.72 (1.46, 2.03) | 0.77 (0.57, 1.03) | 0.57 (0.37, 0.84) | 0.66 (0.54, 0.81) | −2.23 (−2.76, −1.68) | −3,427 (−4,573, −2,281) |
|
| ||||||
| Other | 0.52 (0.39, 0.70) | 1.47 (0.98, 2.16) | 1.32 (0.77, 2.25) | 1.09 (0.81, 1.46) | 0.42 (−0.44, 1.27) | 1,925 (127, 3,733) |
|
| ||||||
| Postoperative complications (vs none) | – | – | 15.38 (12.67, 18.67) | 4.35 (3.84, 4.92) | 9.18 (8.79, 9.58) | 18,806 (17,968, 19,643) |
LOS, length of stay; Ref., referent category.