Temporal trends and volume-outcome associations after traumatic brain injury: a 12-year study in Taiwan

Clinical article

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Object

The purpose of this study was to evaluate temporal trends in traumatic brain injury (TBI); the impact of hospital volume and surgeon volume on length of stay (LOS), hospitalization cost, and in-hospital mortality rate; and to explore predictors of these outcomes in a nationwide population in Taiwan.

Methods

This population-based patient cohort study retrospectively analyzed 16,956 patients who had received surgical treatment for TBI between 1998 and 2009. Bootstrap estimation was used to derive 95% confidence intervals for differences in effect sizes. Hierarchical linear regression models were used to predict outcomes.

Results

Patients treated in very-high-volume hospitals were more responsive than those treated in low-volume hospitals in terms of LOS (−0.11; 95% CI −0.20 to −0.03) and hospitalization cost (−0.28; 95% CI −0.49 to −0.06). Patients treated by high-volume surgeons were also more responsive than those treated by low-volume surgeons in terms of LOS (−0.19; 95% CI −0.37 to −0.01) and hospitalization cost (−0.43; 95% CI −0.81 to −0.05). The mean LOS was 24.3 days and the average LOS for very-high-volume hospitals and surgeons was 61% and 64% shorter, respectively, than that for low-volume hospitals and surgeons. The mean hospitalization cost was US $7,292.10, and the average hospitalization cost for very-high-volume hospitals and surgeons was 19% and 22% lower, respectively, than that for low-volume hospitals and surgeons. Advanced age, male sex, high Charlson Comorbidity Index score, treatment in a low-volume hospital, and treatment by a low-volume surgeon were significantly associated with adverse outcomes (p < 0.001).

Conclusions

The data suggest that annual surgical volume is the key factor in surgical outcomes in patients with TBI. The results improve the understanding of medical resource allocation for this surgical procedure, and can help to formulate public health policies for optimizing hospital resource utilization for related diseases.

Abbreviations used in this paper:BNHI = Bureau of National Health Insurance; CCI = Charlson Comorbidity Index; GCS = Glasgow Coma Scale; LOS = length of stay; TBI = traumatic brain injury.

Article Information

* Drs. Lee and Lin contributed equally to this work.

Address correspondence to: Chih-Lung Lin, M.D., Department of Neurosurgery, Kaohsiung Medical University Hospital, 100 Shih-Chun 1st Road, Kaohsiung 80708, Taiwan, Republic of China. email: hshi@kmu.edu.tw.

Please include this information when citing this paper: published online January 25, 2013; DOI: 10.3171/2012.12.JNS12693.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Bagshaw SMBellomo R: The influence of volume management on outcome. Curr Opin Crit Care 13:5415482007

2

Cadotte DWVachhrajani SPirouzmand F: The epidemiological trends of head injury in the largest Canadian adult trauma center from 1986 to 2007. Clinical article. J Neurosurg 114:150215092011

3

Chiu WTHuang SJTsai SHLin JWTsai MDLin TJ: The impact of time, legislation, and geography on the epidemiology of traumatic brain injury. J Clin Neurosci 14:9309352007

4

Deyo RACherkin DCCiol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:6136191992

5

Funk LMGawande AASemel MELipsitz SRBerry WRZinner MJ: Esophagectomy outcomes at low-volume hospitals: the association between systems characteristics and mortality. Ann Surg 253:9129172011

6

Huang SJHo HLYang CC: Longitudinal outcomes of patients with traumatic brain injury: a preliminary study. Brain Inj 24:160616152010

7

Livingston EHCao J: Procedure volume as a predictor of surgical outcomes. JAMA 304:95972010

8

Mushkudiani NAHukkelhoven CWHernández AVMurray GDChoi SCMaas AI: A systematic review finds methodological improvements necessary for prognostic models in determining traumatic brain injury outcomes. J Clin Epidemiol 61:3313432008

9

Ogilvy CSYang XJamil OAHauck EFHopkins LNSiddiqui AH: Neurointerventional procedures for unruptured intracranial aneurysms under procedural sedation and local anesthesia: a large-volume, single-center experience. Clinical article. J Neurosurg 114:1201282011

10

Ogiso SYamaguchi THata HFukuda MIkai IYamato T: Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc 25:190719122011

11

Panageas KSSchrag DRiedel EBach PBBegg CB: The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med 139:6586652003

12

Pandor AGoodacre SHarnan SHolmes MPickering AFitzgerald P: Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation. Health Technol Assess 15:12022011

13

Peek-Asa CYang JRamirez MHamann CCheng G: Factors affecting hospital charges and length of stay from teenage motor vehicle crash-related hospitalizations among United States teenagers, 2002–2007. Accid Anal Prev 43:5956002011

14

Reaven NLLovett JEFunk SE: Brain injury and fever: hospital length of stay and cost outcomes. J Intensive Care Med 24:1311392009

15

Rosenthal GSanchez-Mejia ROPhan NHemphill JC IIIMartin CManley GT: Incorporating a parenchymal thermal diffusion cerebral blood flow probe in bedside assessment of cerebral autoregulation and vasoreactivity in patients with severe traumatic brain injury. Clinical article. J Neurosurg 114:62702011

16

Saunders-Pullman RWang CStanley KBressman SB: Diagnosis and referral delay in women with Parkinson's disease. Gend Med 8:2092172011

17

Shamim MSQadeer MMurtaza GEnam SAFarooqi NB: Emergency department predictors of tracheostomy in patients with isolated traumatic brain injury requiring emergency cranial decompression. Clinical article. J Neurosurg 115:100710122011

18

Singla ASimons JPCarroll JELi YNg SCTseng JF: Hospital volume as a surrogate for laparoscopically assisted colectomy. Surg Endosc 24:6626692010

19

Stein SCGeorgoff PMeghan SMirza KLEl Falaky OM: Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury. Clinical article. J Neurosurg 112:110511122010

20

Walkey AJWiener RS: Utilization patterns and patient outcomes associated with use of rescue therapies in acute lung injury. Crit Care Med 39:132213282011

21

Warner MAO'Keeffe TBhavsar PShringer RMoore CHarper C: Transfusions and long-term functional outcomes in traumatic brain injury. Clinical article. J Neurosurg 113:5395462010

22

Zheng CKane TDKurland GIrlano KSpahr JPotoka DA: Feasibility of laparoscopic Nissen fundoplication after pediatric lung or heart-lung transplantation: should this be the standard?. Surg Endosc 25:2492542011

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