Table 3.
Three-level Hierarchical Logistic Regression Models to Determine the Association of Surgeon and Hospital Volume with of 30-day Mortality and 30-day Complications
| 30-day mortality | 30-day complications | |||||||
|---|---|---|---|---|---|---|---|---|
| Model controlled for patient characteristics | Model controlled for patient, surgeon and hospital characteristics | Model controlled for patient characteristics | Model controlled for patient, surgeon and hospital characteristics | |||||
|
| ||||||||
| OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | |
| Surgeon volume | ||||||||
| Low (< 4) | Ref | Ref | Ref | Ref | ||||
| High (≥ 4) | 0.54 | 0.33–0.86 | 0.54 | 0.33–0.87 | 0.70 | 0.53–0.94 | 0.71 | 0.55–0.93 |
| Hospital volume | ||||||||
| Low (≤ 10) | Ref | Ref | Ref | Ref | ||||
| High (> 10) | 0.50 | 0.30–0.84 | 0.52 | 0.30–0.92 | 0.92 | 0.68–1.23 | 0.95 | 0.69–1.30 |
| Patient characteristics | ||||||||
| Age group | ||||||||
| < 70 | Ref | Ref | Ref | Ref | ||||
| 70–74 | 1.24 | 0.78–1.95 | 1.22 | 0.77–1.92 | 1.03 | 0.82–1.30 | 1.03 | 0.82–1.30 |
| 75–79 | 1.51 | 0.96–2.37 | 1.49 | 0.95–2.34 | 1.06 | 0.83–1.34 | 1.05 | 0.83–1.33 |
| > 80 | 2.60 | 1.64–4.10 | 2.56 | 1.62–4.05 | 1.40 | 1.08–1.82 | 1.36 | 1.05–1.77 |
| Patient gender | ||||||||
| Male | Ref | Ref | Ref | Ref | ||||
| Female | 0.80 | 0.60–1.07 | 0.79 | 0.59–1.06 | 0.88 | 0.74–1.04 | 0.88 | 0.74–1.04 |
| Race/ethnicity | ||||||||
| Whites | Ref | Ref | Ref | Ref | ||||
| Black | 1.08 | 0.65–1.80 | 1.08 | 0.65–1.80 | 1.17 | 0.86–1.59 | 1.13 | 0.84–1.54 |
| Hispanic/others | 1.01 | 0.59–1.74 | 1.04 | 0.60–1.81 | 0.88 | 0.63–1.22 | 0.88 | 0.63–1.23 |
| Periampullary cancer | 0.63 | 0.45–0.88 | 0.63 | 0.45–0.88 | 0.67 | 0.55–0.82 | 0.68 | 0.56–0.83 |
| Procedure | ||||||||
| Pancreatic head resection | Ref | Ref | Ref | Ref | ||||
| Distal Pancreatic resection | 0.76 | 0.52–1.11 | 0.76 | 0.52–1.11 | 0.68 | 0.55–0.85 | 0.71 | 0.57–0.88 |
| Pancreatectomy not specified | 1.22 | 0.77–1.94 | 1.23 | 0.78–1.96 | 0.87 | 0.66–1.14 | 0.90 | 0.68–1.11 |
| Summary Elixhauser comorbidity score | 1.01 | 0.98–1.03 | 1.01 | 0.99–1.03 | 1.02 | 1.01–1.03 | 1.02 | 1.01–1.04 |
| Surgeon characteristics | ||||||||
| US trained (ref: yes) | 0.88 | 0.54–1.46 | 0.71 | 0.52–0.97 | ||||
| Surgeon gender | ||||||||
| Male | Ref | Ref | ||||||
| Female | 0.84 | 0.36–1.98 | 1.52 | 0.94–2.46 | ||||
| Surgeon specialty | ||||||||
| General surgery | Ref | Ref | ||||||
| Other | 0.84 | 0.52–1.36 | 0.76 | 0.58–1.00 | ||||
| Surgeon’s age | 0.96 | 0.89–1.04 | 1.02 | 0.98–1.07 | ||||
| Surgeon’s year of practice | 1.04 | 0.97–1.11 | 0.99 | 0.95–1.03 | ||||
| Hospital Characteristics | ||||||||
| Hospital type | ||||||||
| Non-profit | Ref | Ref | ||||||
| Profit | 0.85 | 0.51–1.42 | 1.26 | 0.89–1.77 | ||||
| Government | 0.86 | 0.47–1.56 | 0.99 | 0.70–1.41 | ||||
| Hospital bed size | ||||||||
| <200 | Ref | Ref | ||||||
| 200–350 | 1.06 | 0.59–1.91 | 0.79 | 0.52–1.20 | ||||
| 351–500 | 0.75 | 0.40–1.40 | 0.76 | 0.51–1.14 | ||||
| >500 | 0.75 | 0.40–1.38 | 0.62 | 0.41–0.93 | ||||
| Hospital status | ||||||||
| Major | Ref | Ref | ||||||
| Minor | 0.67 | 0.38–1.17 | 0.62 | 0.44–0.88 | ||||
| No-teaching | 0.73 | 0.40–1.33 | 0.53 | 0.37–0.78 | ||||