Original articleGeneral thoracicContinued Relevance of Minimum Volume Standards for Elective Esophagectomy: A National Perspective
Section snippets
Patients and Methods
The 2010 to 2018 Nationwide Readmissions Database (NRD) was used to identify all elective adult (≥18 years) hospitalizations for esophagectomy. Maintained as a part of the Healthcare Cost and Utilization Project, the NRD provides accurate estimates for up to 57.8% of all U.S. hospitalizations using robust sampling methodologies and survey weights.5 The study cohort was derived from nearly 17 million annual hospitalizations using International Classification of Diseases (ICD)–Ninth and Tenth
Results
During the study period, an estimated 23,176 patients underwent elective esophagectomy for malignancy, with an increase in annual volume from 2137 cases in 2010 to 3016 in 2018. The number of unique hospitals performing an elective esophagectomy increased from 296 in 2010 to 481 in 2018, while the median institutional caseload increased from 2 (IQR, 1-5) to 3 (IQR, 1-7) over the same period (all NPtrend < 0.001). The proportion of hospitals considered HVH according to Leapfrog criteria remained
Comment
Administration of minimum volume thresholds to ensure quality of complex operations has faced numerous challenges in the United States.13 While a large body of literature over the past 2 decades has demonstrated a significant volume-outcome relationship, critics have suggested real-world irrelevance of minimum volume requirements with general improvements in perioperative safety.4 In the present study, we characterized the association of volume thresholds on outcomes of elective esophagectomy
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2022, Surgery Open ScienceCitation Excerpt :The NRD is a national, all-payer database maintained by the Healthcare Cost and Utilization Project (HCUP) that accrues data from 27 states and provides accurate estimates for approximately 60% of all US hospitalizations. Previously reported International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (ICD-9/10-CM) diagnosis and procedure codes were used to identify hospitalizations for esophagectomy for benign and malignant indications [12]. Records with missing data for age, sex, in-hospital mortality, or hospitalization costs were excluded (4.1%).