Osong Public Health Res Perspect.  2017 Feb;8(1):34-46. 10.24171/j.phrp.2017.8.1.05.

Analysis of Hospital Volume and Factors Influencing Economic Outcomes in Cancer Surgery: Results from a Population-based Study in Korea

• Lee JA
• Kim SY
• Park K
• Park EC
• Park JH

• KMID: 2386099
• DOI: http://doi.org/10.24171/j.phrp.2017.8.1.05

Abstract

OBJECTIVES
To evaluate associations between hospital volume, costs, and length of stay (LOS), and clinical and demographic outcome factors for five types of cancer resection. The main dependent variables were cost and LOS; the primary independent variable was volume.
METHODS
Data were obtained from claims submitted to the Korean National Health Insurance scheme. We identified patients who underwent the following surgical procedures: pneumonectomy, colectomy, mastectomy, cystectomy, and esophagectomy. Hospital volumes were divided into quartiles.
RESULTS
Independent predictors of high costs and long LOS included old age, low health insurance contribution, non-metropolitan residents, emergency admission, Charlson score > 2, public hospital ownership, and teaching hospitals. After adjusting for relevant factors, there was an inverse relationship between volume and costs/LOS. The highest volume hospitals had the lowest procedure costs and LOS. However, this was not observed for cystectomy.
CONCLUSION
Our findings suggest an association between patient and clinical factors and greater costs and LOS per surgical oncologic procedure, with the exception of cystectomy. Yet, there were no clear associations between hospitals' cost of care and risk-adjusted mortality.

Keyword

neoplasms; surgical procedures; operative; hospital costs; length of stay; hospitalization

MeSH Terms

Colectomy
Cystectomy
Emergencies
Esophagectomy
Hospital Costs
Hospitalization
Hospitals, Public
Hospitals, Teaching
Humans
Insurance, Health
Korea*
Length of Stay
Mastectomy
Mortality
National Health Programs
Ownership
Pneumonectomy