Length of Stay and Cost in Patients Undergoing Orthognathic Surgery: Does Surgeon Volume Matter?

Avni Gupta; Ritam Chowdhury; R Sterling Haring; Leah I Leinbach; John Petrone; Martin J Spitzer; Eric B Schneider

doi:10.1016/j.joms.2017.04.041

Length of Stay and Cost in Patients Undergoing Orthognathic Surgery: Does Surgeon Volume Matter?

J Oral Maxillofac Surg. 2017 Sep;75(9):1948-1957. doi: 10.1016/j.joms.2017.04.041. Epub 2017 May 10.

Authors

Avni Gupta¹, Ritam Chowdhury², R Sterling Haring³, Leah I Leinbach⁴, John Petrone⁵, Martin J Spitzer⁶, Eric B Schneider⁷

Affiliations

¹ Senior Research Assistant, Center for Surgery and Public Health, Harvard Medical School, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA.
² Research Associate, Center for Surgery and Public Health, Harvard Medical School, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA.
³ Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁴ Assistant Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
⁵ Program Director of Dental Residency, Assistant Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
⁶ Associate Professor, Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Bonn, Bonn, Germany.
⁷ Director of Quantitative Science, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: eschnei1@jhmi.edu.

PMID: 28576668
DOI: 10.1016/j.joms.2017.04.041

Abstract

Purpose: The relations among procedure-specific annual surgeon volume, hospital length of stay (LOS), and hospital costs for patients undergoing the 2 most common orthognathic surgical (OGS) procedures, segmental osteoplasty or osteotomy of the maxilla (SOM) or open osteoplasty or osteotomy of the mandibular ramus (SOMR), are not known. The authors hypothesized that treatment by high-volume surgeons would be associated with decreased LOS and costs.

Materials and methods: All patients 8 to 64 years old who underwent elective SOM or SOMR were selected from the 2001 to 2009 Nationwide Inpatient Sample. Patients with missing vital status or payment mode status or who underwent more than 1 OGS procedure during the index hospitalization were excluded. Based on year- and procedure-specific annual surgeon volumes, the highest (highest quartile) and lowest (lowest quartile) procedure volume surgeon groups were compared. Multivariable logistic regression was used to study the relation between surgeon volume and extended patient LOS (defined as LOS ≥ 75th percentile). Generalized linear models with a log-link and gamma distribution were used to examine the association between surgeon volume and hospital costs. Models were adjusted for patient- and hospital-level factors and type of procedure (SOM or SOMR). Analysis was weighted to represent national-level estimates and an α value of 0.05 was used for all comparisons.

Results: After weighting to the population level, 8,062 patients were included for study. Most were white (80.6%), female (61.4%), and privately insured (84.6%). Mean age was 26 years (standard deviation, 0.38 yr). After adjusting for potential confounders, patients treated by high-volume surgeons showed 40% lower odds of extended LOS (odds ratio = 0.60; 95% confidence interval [CI], 0.38-0.95; P = .032) and incurred substantially lower costs (-$1,484.74; 95% CI, -2,782.76 to -185.58; P = .025) compared with patients treated by low-volume surgeons.

Conclusion: These findings suggest that regionalization of patients to high-volume surgeons for OGS procedures could decrease LOS and incurred costs.

MeSH terms

Adolescent
Adult
Child
Clinical Competence*
Female
Hospital Costs
Hospitals, High-Volume*
Humans
Length of Stay / economics*
Male
Middle Aged
Orthognathic Surgical Procedures / economics*
United States