Which kind of provider's operation volumes matters? Associations between CABG surgical site infection risk and hospital and surgeon operation volumes among medical centers in Taiwan
Journal
PLoS ONE
Journal Volume
10
Journal Issue
6
Pages
e0129178
Date Issued
2015
Author(s)
Abstract
Background: Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG) surgical site infections (SSIs) as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented. Methods: A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes and a Classification and Regression Trees (CART) model. Two definitions of surgeon and hospital operation volumes were used: (1) the cumulative CABG operation volumes within the study period; and (2) the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1) a continuous variable; (2) a categorical variable based on the quartile; and (3) a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted. Results: This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon's volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons. Conclusion: Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and SSIs in Taiwan. However, the relationships were not robust. Definitions and categorization methods of operation volume and correct identification of SSIs are important issues for future research. ? 2015 Yu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
aged; Article; comorbidity; coronary artery bypass graft; cross-sectional study; disease association; female; hospital management; hospital service; human; infection risk; major clinical study; male; patient identification; risk assessment; surgeon operation volume; surgical infection; Taiwan; adverse effects; coronary artery bypass graft; hospital; International Classification of Diseases; multilevel analysis; risk factor; statistics and numerical data; surgeon; Surgical Wound Infection; university hospital; Academic Medical Centers; Aged; Coronary Artery Bypass; Female; Hospitals; Humans; International Classification of Diseases; Male; Multilevel Analysis; Risk Factors; Surgeons; Surgical Wound Infection; Taiwan
Publisher
Public Library of Science
Type
journal article