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Hiromasa Horiguchi - One of the best experts on this subject based on the ideXlab platform.

  • relationship between Hospital Volume and hemorrhagic complication after percutaneous renal biopsy results from the japanese diagnosis procedure combination database
    Clinical and Experimental Nephrology, 2015
    Co-Authors: Hiroyuki Yamamoto, Hideki Hashimoto, Hiromasa Horiguchi, Mitsuhiro Nakamura, Hideo Yasunaga
    Abstract:

    Background Although hemorrhagic complications are major complications of percutaneous renal biopsy (PRB), the relationship between procedure Volume and morbidity remains unclear for PRB. The present study investigated the impact of Hospital Volume on the occurrence of hemorrhagic complications after PRB.

  • Hospital Volume and cardiac complications of endomyocardial biopsy a retrospective cohort study of 9508 adult patients using a nationwide inpatient database in japan
    Clinical Cardiology, 2015
    Co-Authors: Toshiaki Isogai, Hideo Yasunaga, Hiromasa Horiguchi, Hiroki Matsui, Tetsuro Ueda, Hiroyuki Tanaka, Kiyohide Fushimi
    Abstract:

    Background Recent research on complications with endomyocardial biopsy (EMB) has been based on single-center or 2-center studies in high-Volume cardiovascular centers. No study has examined the association between Hospital Volume and the complication rate after EMB. Hypothesis Hospital Volume is inversely associated with cardiac complication rate after EMB. Methods Using the Diagnosis Procedure Combination database in Japan, we identified inpatients aged ≥20 years who underwent EMB under fluoroscopic guidance. We assessed cardiac complications requiring the following urgent procedures on the day of EMB or the day after: pericardiocentesis, surgical repair, and temporary pacing. Results Among 9508 eligible patients in 491 Hospitals (male, 68%; mean age, 57.0 years), dilated cardiomyopathy was the most frequently diagnosed condition (35.4%). Twenty-four patients (0.25%) required pericardiocentesis on the day of EMB. Three patients (0.03%) underwent surgical repair on the day of EMB or the day after. Sixty-three patients (0.70%) required temporary pacing on the day of EMB. Higher Hospital Volume was associated with lower rates of pericardiocentesis (low Volume, 0.4%; medium Volume, 0.2%; high Volume, 0.1%; P for the trend test, 0.019) and temporary pacing (low Volume, 1.0%; medium Volume, 0.7%; high Volume, 0.2%; P for the trend test, < 0.001). In a multivariable logistic regression analysis, high Hospital Volume was significantly associated with a lower rate of the composite outcome of the procedures (reference, low Volume; adjusted odds ratio, 0.22; 95% confidence interval, 0.08–0.62, P = 0.004). Conclusions Serious cardiac complications of EMB were rare, but higher Hospital Volume was associated with lower complication rate.

  • impact of Hospital Volume on Hospital mortality length of stay and total costs after pancreaticoduodenectomy
    British Journal of Surgery, 2014
    Co-Authors: R Yoshioka, Hideo Yasunaga, Hiromasa Horiguchi, Kiyohide Fushimi, Kiyoshi Hasegawa, Taku Aoki, Y Sakamoto, Yasuhiko Sugawara, Norihiro Kokudo
    Abstract:

    Background High morbidity and mortality rates after pancreaticoduodenectomy (PD) have led to concentration of this surgery in high-Volume centres, with improved outcomes. The extent to which better outcomes might be apparent in a healthcare system where the mortality rate is already low is unclear. Methods The Japanese Diagnosis Procedure Combination database was used to identify patients undergoing PD between 2007 and 2010. Patient data included age, sex, co-morbidities at admission, type of Hospital, type of PD, and the year in which the patient was treated. Hospital Volume was defined as the number of PDs performed annually at each Hospital, and categorized into quintiles: very low-, low-, medium-, high- and very high-Volume groups. The Charlson co-morbidity index was calculated using the International Classification of Diseases, tenth revision, codes of co-morbidities. Results A total of 10 652 patients who underwent PD in 848 Hospitals were identified. The overall in-Hospital mortality rate after PD was 3·3 per cent (350 of 10 652), and for the groups ranged from 5·0 per cent for the very low-Volume group to 1·4 per cent for the very high-Volume group (P < 0·001). Multivariable analysis revealed a significant linear relationship between higher Hospital Volume and shorter postoperative length of stay compared with the very low-Volume group, and between increasing Hospital Volume and lower total costs. Conclusion A significant relationship exists between increasing Hospital Volume, lower in-Hospital mortality, shorter length of stay and lower costs for patients undergoing PD in Japan. Centralization of PD in this healthcare system is therefore justified.

  • impact of Hospital Volume on outcomes in acute pancreatitis a study using a nationwide administrative database
    Journal of Gastroenterology, 2014
    Co-Authors: Tsuyoshi Hamada, Hideo Yasunaga, Hiromasa Horiguchi, Kiyohide Fushimi, Yousuke Nakai, Hiroyuki Isayama, Kazuhiko Koike
    Abstract:

    Background Although several population-based studies have shown higher Hospital Volume (HV) to be associated with better outcomes in acute pancreatitis, they failed to adjust for disease severity and did not take into account the potentially non-linear relationship between HV and outcomes. Using a Japanese nationwide administrative database, this study aimed to evaluate the Volume–outcome relationship in acute pancreatitis by means of statistical methods that permitted such considerations.

  • impact of Hospital Volume on postoperative complications and in Hospital mortality after musculoskeletal tumor surgery analysis of a national administrative database
    Journal of Bone and Joint Surgery American Volume, 2013
    Co-Authors: Koichi Ogura, Hideo Yasunaga, Hiromasa Horiguchi, Sakae Tanaka, Yusuke Shinoda, Kazuhiko Ohe, Hirotaka Kawano
    Abstract:

    Background: We are aware of only one report describing the relationship between operative Volume and outcomes in musculoskeletal tumor surgery, although numerous studies have described such relationships in other surgical procedures. The aim of the present study was to use a nationally representative inpatient database to evaluate the impact of Hospital Volume on the rates of postoperative complications and in-Hospital mortality after musculoskeletal tumor surgery. Methods: We used the Japanese Diagnostic Procedure Combination administrative database to retrospectively identify 4803 patients who had undergone musculoskeletal tumor surgery during 2007 to 2010. Patients were then divided into tertiles of approximately equal size on the basis of the annual Hospital Volume (number of patients undergoing musculoskeletal tumor surgery): low, twelve or fewer cases/year; medium, thirteen to thirty-one cases/year; and high, thirty-two or more cases/year. Logistic regression analyses were performed to examine the relationships between various factors and the rates of postoperative complications and in-Hospital mortality adjusted for all patient demographic characteristics. Results: The overall postoperative complication rate was 7.2% (348 of 4803), and the in-Hospital mortality rate was 2.4% (116 of 4803). Postoperative complications included surgical site infections in 132 patients (2.7%), cardiac events in sixty-four (1.3%), respiratory complications in fifty-one (1.1%), sepsis in thirty-one (0.6%), pulmonary emboli in sixteen (0.3%), acute renal failure in eleven (0.2%), and cerebrovascular events in seven (0.1%). The postoperative complication rate was related to the duration of anesthesia (odds ratio [OR] for a duration of more than 240 compared with less than 120 minutes, 2.44; 95% confidence interval [CI], 1.68 to 3.53; p < 0.001) and to Hospital Volume (OR for high compared with low Volume, 0.73; 95% CI, 0.55 to 0.96; p = 0.027). The mortality rate was related to the diagnosis (OR for a metastatic compared with a primary bone tumor, 3.67; 95% CI, 1.66 to 8.09; p = 0.001), type of surgery (OR for amputation compared with soft-tissue tumor resection without prosthetic reconstruction, 3.81; 95% CI, 1.42 to 10.20; p = 0.008), and Hospital Volume (OR for high compared with low Volume, 0.26; 95% CI, 0.14 to 0.50; p < 0.001). Conclusions: We identified an independent effect of Hospital Volume on outcomes after adjusting for patient demographic characteristics. We recommend regionalization of musculoskeletal tumor surgery to high-Volume Hospitals in an attempt to improve patient outcomes. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Hideo Yasunaga - One of the best experts on this subject based on the ideXlab platform.

  • Hospital Volume effects on perioperative outcomes in peritoneal dialysis catheter implantation analysis of 2 505 cases
    Peritoneal Dialysis International, 2018
    Co-Authors: Yoshitaka Kinoshita, Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Toru Sugihara, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Yoshitaka Ishibashi, Yukio Homma
    Abstract:

    BackgroundEvidence regarding Volume-outcome effects on peritoneal dialysis (PD) catheter implantation is limited. This study aimed to investigate associations between Hospital Volume (annual caselo...

  • relationship between Hospital Volume and outcomes in patients with traumatic brain injury a retrospective observational study using a national inpatient database in japan
    Injury-international Journal of The Care of The Injured, 2017
    Co-Authors: Tomoki Wada, Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Kent Doi, Yoichi Kitsuta, Susumu Nakajima
    Abstract:

    Abstract Background The relationship between Hospital Volume and outcome after traumatic brain injury (TBI) is not completely understood in a real clinical setting. We investigated whether patients admitted with TBI achieved better outcomes in high-Volume Hospitals than in low-Volume Hospitals using a national inpatient database in Japan. Methods This retrospective cohort study used the Diagnosis Combination Procedure database in Japan. We included patients with TBI admitted to Hospitals with a Japan Coma Scale (JCS) score ≥2 between April 1, 2013 and March 31, 2014. Hospital Volume was defined as the annual number of all admissions with TBI in individual Hospitals. The Hospital Volume was categorized into four Volume groups: low (≤60 admissions per Hospital), medium-low (61–120 admissions per Hospital), medium-high (121–180 admissions per Hospital) and high (≥181 admissions per Hospital). The outcomes of interest included 28-day mortality and survival discharge with complete dependency defined as a Barthel Index score of 0 at discharge. We used multivariate logistic regression models fitted with generalized estimating equations to evaluate relationships between the Hospital Volume and the outcomes. The Hospital Volume was evaluated both as categorical variables defined above and as continuous variables. Results The analysis dataset consisted of 20,146 eligible patients. Of these, 2,784 died within 28 days (13.8%) and 3,409 were completely dependent among 16,996 patients discharged alive (20.1%). Multivariate analyses found that there was no significant difference between the high-Volume and low-Volume groups for 28-day mortality (adjusted odds ratio [OR] 0.79, 95% confidence interval [CI] 0.58–1.06 for the high-Volume group) or complete dependency at discharge (adjusted OR 0.94, 95% CI 0.71–1.23 for the high-Volume group). The results were the same when the Hospital Volume was evaluated as a continuous variable. Conclusions Hospital Volume did not appear to influence outcomes in patients with TBI. High-Volume Hospitals may not be necessarily beneficial for patients with TBI exhibiting impaired consciousness as a whole.

  • Hospital Volume and mortality in mechanically ventilated children analysis of a national inpatient database in japan
    Pediatric Critical Care Medicine, 2016
    Co-Authors: Ryuji Sasaki, Hideo Yasunaga, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi
    Abstract:

    OBJECTIVES To evaluate the relationship between annual Hospital Volume of mechanical ventilation in children and mortality. DESIGN A retrospective analysis. SETTING Japanese Hospitals (n = 641) in the Japanese Diagnosis Procedure Combination database from July 2010 to March 2013. PATIENTS Patients 15 years old or younger receiving mechanical ventilation during Hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 26,981 mechanically ventilated pediatric patients were identified. They were categorized into four subgroups based on the quartiles of mean annual Hospital Volume of mechanical ventilation in children. Multivariable logistic regression analyses were performed to examine the effects of Hospital Volume on 30-day mortality, with adjustment for patient and Hospital characteristics. Compared with the low Volume group (≤ 34 per year), the odds ratios (95% CI) for 30-day mortality of low-medium (35-80), medium-high (81-165), and high (≥ 166) Volume groups were 0.63 (0.50-0.79), 0.56 (0.42-0.74), and 0.57 (0.50-0.79), respectively. Subgroup analyses of surgical and nonsurgical patients showed similar trends. CONCLUSIONS In mechanically ventilated pediatric patients divided by Hospital Volume quartiles, all three higher Volume groups had lower mortality than the lowest Volume group.

  • Hospital Volume and the occurrence of bleeding and perforation after colorectal endoscopic submucosal dissection analysis of a national administrative database in japan
    Diseases of The Colon & Rectum, 2015
    Co-Authors: Hiroyuki Odagiri, Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Toshiro Iizuka, Mitsuru Kaise
    Abstract:

    BACKGROUND Colorectal endoscopic submucosal dissection has gained popularity as a minimally invasive technique for the treatment of colorectal neoplasms in many countries, including Japan. However, most previous studies of endoscopic submucosal dissection had relatively small sample sizes and only included patients treated at specialized centers. Associations between Hospital Volume and complication rates after colorectal endoscopic submucosal dissection are still poorly understood. OBJECTIVE Our aim was to clarify the relationships between Hospital Volume and the occurrence rates of bleeding and perforation after colorectal endoscopic submucosal dissection. DESIGN This was a retrospective cohort study. Hospital Volume was defined as the number of colorectal endoscopic submucosal dissections performed at each Hospital between April 2012 and March 2013 and was categorized into the following quartiles: 1) very low-Volume (18 or less patients during the year), 2) low-Volume (19-35 patients), 3) high-Volume (36-58 patients), and 4) very high-Volume (59 or more). SETTINGS This study was based on a national inpatient data from the Japanese Diagnosis Procedure Combination database. PATIENTS A total of 7567 patients with colorectal endoscopic submucosal dissection were included. MAIN OUTCOME MEASURES Severe postoperative bleeding requiring endoscopic hemostasis or blood transfusion within 1 week after endoscopic submucosal dissection and perforation requiring open surgery were the main outcomes measured. RESULTS Severe postoperative bleeding and perforation occurred in 331 (4.4%) and 13 patients (0.2%). Multivariable logistic regression analysis showed that the very high Hospital Volume group had a significantly lower proportion of severe postoperative bleeding than the very low Hospital Volume group (OR = 0.48 [95 % CI, 0.27-0.83]; p = 0.009). LIMITATIONS This study lacked some information on clinicopathologic features including en bloc resection, curative resection, and relapse. Individual endoscopist experience could not be analyzed. CONCLUSIONS The present study clearly showed a significant association between higher Hospital Volume and lower occurrence of severe postoperative bleeding.

  • relationship between Hospital Volume and hemorrhagic complication after percutaneous renal biopsy results from the japanese diagnosis procedure combination database
    Clinical and Experimental Nephrology, 2015
    Co-Authors: Hiroyuki Yamamoto, Hideki Hashimoto, Hiromasa Horiguchi, Mitsuhiro Nakamura, Hideo Yasunaga
    Abstract:

    Background Although hemorrhagic complications are major complications of percutaneous renal biopsy (PRB), the relationship between procedure Volume and morbidity remains unclear for PRB. The present study investigated the impact of Hospital Volume on the occurrence of hemorrhagic complications after PRB.

Shinya Matsuda - One of the best experts on this subject based on the ideXlab platform.

  • association between Hospital Volume and outcomes of elderly and non elderly patients with acute biliary diseases a national administrative database analysis
    Geriatrics & Gerontology International, 2013
    Co-Authors: Atsuhiko Murata, Shinya Matsuda, Kazuaki Kuwabara, Yoshihisa Fujino, Tatsuhiko Kubo, Kenji Fujimori, Yukako Ichimiya, Yasufumi Matsuda, Hiromasa Horiguchi
    Abstract:

    Aim:  This study aimed to investigate the relationship between Hospital Volume and clinical outcomes of elderly and non-elderly patients with acute biliary diseases using data from a national administrative database. Methods:  Overall, 26 720 elderly and 33 774 non-elderly patients with acute biliary diseases were referred to 820 Hospitals in Japan. Hospital Volume was categorized into three groups based on the case numbers during the study period: low-Volume, medium-Volume and high-Volume. We compared the risk-adjusted length of stay (LOS) and in-Hospital mortality in relation to Hospital Volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases. Results:  Multiple linear regression analyses showed that increased Hospital Volume was significantly associated with shorter LOS in both elderly and non-elderly patients with and without invasive treatments. Increased Hospital Volume was significantly associated with decreased relative risk of in-Hospital mortality in elderly patients. The odds ratio for high-Volume Hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533–0.847, P = 0.001) and 0.715 in those with invasive treatments (95% C, 0.566–0.904, P = 0.005). However, no significant differences for in-Hospital mortality were seen in non-elderly patients with and without invasive treatments. Conclusion:  This study has highlighted that higher Volume Hospitals significantly reduced LOS and in-Hospital mortality for elderly patients with acute biliary diseases, but not non-elderly patients. The current results are of value for elderly healthcare policy decision-making, and highlight the need for further studies into the quality of care for elderly patients. Geriatr Gerontol Int 2013; 13: 731–740.

  • relationship between Hospital Volume and operative mortality for liver resection data from the japanese diagnosis procedure combination database
    Hepatology Research, 2012
    Co-Authors: Hideo Yasunaga, Hiromasa Horiguchi, Kazuhiko Ohe, Shinya Matsuda, Kiyohide Fushimi, Hideki Hashimoto, Norihiro Kokudo
    Abstract:

    Aim:  The present study aimed to conduct a nationwide investigation on the relationship between Hospital Volume and outcomes following liver resection in Japan. We also discuss health policy implications of the results. Methods:  Using the Japanese Diagnosis Procedure Combination database, we identified 18 046 patients who underwent hepatic resection between July and December 2007–2009. Patients were subdivided into Hospital-Volume quartiles: very low- ( 70). Multivariate logistic regression analysis for in-Hospital mortality within 30 days of surgery was performed to analyze adjusted effects of various factors. Results:  Patients in the very high-Volume group had a higher Charlson Comorbidity Index (P < 0.001) than those in the very low-Volume group. Very low-Volume Hospitals were significantly less likely to perform extended lobectomy than very high-Volume Hospitals (5.4% vs 17.6%, P < 0.001). Crude in-Hospital mortality within 30 days of surgery was 1.1% (0.6%, 0.8%, 1.9% and 3.0% for limited resection, segmentectomy, lobectomy and extended lobectomy, respectively). With reference to the very low-Volume group, risk-adjusted odds ratios (95% confidence intervals) of low-, high- and very high-Volume groups for overall mortality were 0.70 (0.48–1.02; P = 0.060), 0.52 (0.34–0.81; P = 0.004) and 0.16 (0.09–0.30; P < 0.001), respectively. Conclusion:  There is a linear trend between higher Hospital Volume and lower in-Hospital mortality of liver resection in Japan, particularly for lobectomy and extended lobectomy. Based on these results, regionalization of lobectomy and extended lobectomy in high-Volume centers could be effective for reducing postoperative mortality.

  • effect of Hospital Volume on clinical outcome in patients with acute pancreatitis based on a national administrative database
    Pancreas, 2011
    Co-Authors: Atsuhiko Murata, Shinya Matsuda, Kazuaki Kuwabara, Yoshihisa Fujino, Tatsuhiko Kubo, Kenji Fujimori, Yukako Ichimiya, Toshihiko Mayumi, Masamichi Yokoe, Hiromasa Horiguchi
    Abstract:

    Objective:This study aimed to investigate the relationship between Hospital Volume and clinical outcome in patients with acute pancreatitis, using a Japanese national administrative database.Methods:A total of 7007 patients with acute pancreatitis were referred to776 Hospitals in Japan. Patient data

  • impact of Hospital Volume on chest tube duration length of stay and mortality after lobectomy
    The Annals of Thoracic Surgery, 2011
    Co-Authors: Hiroshi Otake, Hideo Yasunaga, Hiromasa Horiguchi, Shinya Matsuda, Noriyuki Matsutani, Kazuhiko Ohe
    Abstract:

    Background Numerous studies have suggested an inverse relationship between Hospital Volume and short-term mortality after various major operations. However, the Volume-outcome relationship after lung cancer surgery remains controversial. We investigated the effects of Hospital Volume on various outcomes after lobectomy for lung cancer, including chest tube duration, postoperative length of stay, and in-Hospital mortality. Methods From a total of 5.85 million inpatients in the Japanese Diagnosis Procedure Combination database, we identified 19,831 patients who underwent lobectomy for lung cancer between July and December in 2007 and 2008. Patients were divided into low (≤24 per year), medium-low (25 to 43), medium-high (44 to 67), or high (≥68) Hospital-Volume groups. Multivariate regression analyses were conducted to analyze the concurrent effects of various factors on postoperative outcomes. Results Overall in-Hospital mortality was 0.69%, and was significantly lower in the high-Volume group compared with the low-Volume group (0.48% versus 0.94%; odds ratio 0.60; p = 0.047). Chest tube removal occurred earlier in the high-Volume group than in the low-Volume group (mean 4.0 days versus 5.1; p p Conclusions Higher Hospital Volume was associated with significantly shorter chest tube duration and postoperative length of stay, and lower in-Hospital mortality after lobectomy for lung cancer. However, the differences in outcomes between high-Volume and low-Volume Hospitals may be too small to support regionalization of lung cancer operations to high-Volume centers.

  • an observational study using a national administrative database to determine the impact of Hospital Volume on compliance with clinical practice guidelines
    Medical Care, 2011
    Co-Authors: Atsuhiko Murata, Shinya Matsuda, Kazuaki Kuwabara, Yoshihisa Fujino, Tatsuhiko Kubo, Kenji Fujimori, Hiromasa Horiguchi
    Abstract:

    BACKGROUND Little information is available on the relationship between Hospital Volume and compliance with clinical practice guidelines (CPGs). OBJECTIVES To investigate the relationship between Hospital Volume and compliance with CPGs using a Japanese administrative database. DESIGN AND SUBJECTS This was an observational study that included 60,842 patients with acute cholangitis from 829 Hospitals in Japan. MEASURES Hospital Volume was categorized into the following 3 groups based on the number of cases of acute cholangitis during the study period: low-Volume Hospitals (LVHs; n = 20,869), medium-Volume Hospitals (MVHs; n = 18,387), and high-Volume Hospitals (HVHs; n = 21,586). We further collected patient data with regard to CPGs for acute cholangitis, and counted the number of recommendations that had been complied with for each patient. CPGs compliance score was defined as the rate of compliance with these recommendations for each patient (range, 0-10). Aggregated CPGs compliance score was measured according to Hospital Volume. RESULTS Mean CPGs compliance score in HVHs was significantly higher than that in MVHs and LVHs (6.8 ± 1.6 vs. 5.6 ± 1.5 vs. 3.9 ± 1.4, respectively; P < 0.001). Multiple linear regression analysis revealed that Hospital Volume was most significantly associated with CPGs compliance score. The standardized coefficient for CPGs compliance score in HVHs was 0.689, whereas that of MVHs was 0.366 (P < 0.001). CONCLUSIONS This study demonstrated that Hospital Volume was significantly associated with compliance with CPGs and that the Japanese administrative database was a viable tool for the monitoring of compliance with CPGs.

Kiyohide Fushimi - One of the best experts on this subject based on the ideXlab platform.

  • Hospital Volume effects on perioperative outcomes in peritoneal dialysis catheter implantation analysis of 2 505 cases
    Peritoneal Dialysis International, 2018
    Co-Authors: Yoshitaka Kinoshita, Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Toru Sugihara, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Yoshitaka Ishibashi, Yukio Homma
    Abstract:

    BackgroundEvidence regarding Volume-outcome effects on peritoneal dialysis (PD) catheter implantation is limited. This study aimed to investigate associations between Hospital Volume (annual caselo...

  • relationship between Hospital Volume and outcomes in patients with traumatic brain injury a retrospective observational study using a national inpatient database in japan
    Injury-international Journal of The Care of The Injured, 2017
    Co-Authors: Tomoki Wada, Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Kent Doi, Yoichi Kitsuta, Susumu Nakajima
    Abstract:

    Abstract Background The relationship between Hospital Volume and outcome after traumatic brain injury (TBI) is not completely understood in a real clinical setting. We investigated whether patients admitted with TBI achieved better outcomes in high-Volume Hospitals than in low-Volume Hospitals using a national inpatient database in Japan. Methods This retrospective cohort study used the Diagnosis Combination Procedure database in Japan. We included patients with TBI admitted to Hospitals with a Japan Coma Scale (JCS) score ≥2 between April 1, 2013 and March 31, 2014. Hospital Volume was defined as the annual number of all admissions with TBI in individual Hospitals. The Hospital Volume was categorized into four Volume groups: low (≤60 admissions per Hospital), medium-low (61–120 admissions per Hospital), medium-high (121–180 admissions per Hospital) and high (≥181 admissions per Hospital). The outcomes of interest included 28-day mortality and survival discharge with complete dependency defined as a Barthel Index score of 0 at discharge. We used multivariate logistic regression models fitted with generalized estimating equations to evaluate relationships between the Hospital Volume and the outcomes. The Hospital Volume was evaluated both as categorical variables defined above and as continuous variables. Results The analysis dataset consisted of 20,146 eligible patients. Of these, 2,784 died within 28 days (13.8%) and 3,409 were completely dependent among 16,996 patients discharged alive (20.1%). Multivariate analyses found that there was no significant difference between the high-Volume and low-Volume groups for 28-day mortality (adjusted odds ratio [OR] 0.79, 95% confidence interval [CI] 0.58–1.06 for the high-Volume group) or complete dependency at discharge (adjusted OR 0.94, 95% CI 0.71–1.23 for the high-Volume group). The results were the same when the Hospital Volume was evaluated as a continuous variable. Conclusions Hospital Volume did not appear to influence outcomes in patients with TBI. High-Volume Hospitals may not be necessarily beneficial for patients with TBI exhibiting impaired consciousness as a whole.

  • Hospital Volume and mortality in mechanically ventilated children analysis of a national inpatient database in japan
    Pediatric Critical Care Medicine, 2016
    Co-Authors: Ryuji Sasaki, Hideo Yasunaga, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi
    Abstract:

    OBJECTIVES To evaluate the relationship between annual Hospital Volume of mechanical ventilation in children and mortality. DESIGN A retrospective analysis. SETTING Japanese Hospitals (n = 641) in the Japanese Diagnosis Procedure Combination database from July 2010 to March 2013. PATIENTS Patients 15 years old or younger receiving mechanical ventilation during Hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 26,981 mechanically ventilated pediatric patients were identified. They were categorized into four subgroups based on the quartiles of mean annual Hospital Volume of mechanical ventilation in children. Multivariable logistic regression analyses were performed to examine the effects of Hospital Volume on 30-day mortality, with adjustment for patient and Hospital characteristics. Compared with the low Volume group (≤ 34 per year), the odds ratios (95% CI) for 30-day mortality of low-medium (35-80), medium-high (81-165), and high (≥ 166) Volume groups were 0.63 (0.50-0.79), 0.56 (0.42-0.74), and 0.57 (0.50-0.79), respectively. Subgroup analyses of surgical and nonsurgical patients showed similar trends. CONCLUSIONS In mechanically ventilated pediatric patients divided by Hospital Volume quartiles, all three higher Volume groups had lower mortality than the lowest Volume group.

  • Hospital Volume and the occurrence of bleeding and perforation after colorectal endoscopic submucosal dissection analysis of a national administrative database in japan
    Diseases of The Colon & Rectum, 2015
    Co-Authors: Hiroyuki Odagiri, Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Toshiro Iizuka, Mitsuru Kaise
    Abstract:

    BACKGROUND Colorectal endoscopic submucosal dissection has gained popularity as a minimally invasive technique for the treatment of colorectal neoplasms in many countries, including Japan. However, most previous studies of endoscopic submucosal dissection had relatively small sample sizes and only included patients treated at specialized centers. Associations between Hospital Volume and complication rates after colorectal endoscopic submucosal dissection are still poorly understood. OBJECTIVE Our aim was to clarify the relationships between Hospital Volume and the occurrence rates of bleeding and perforation after colorectal endoscopic submucosal dissection. DESIGN This was a retrospective cohort study. Hospital Volume was defined as the number of colorectal endoscopic submucosal dissections performed at each Hospital between April 2012 and March 2013 and was categorized into the following quartiles: 1) very low-Volume (18 or less patients during the year), 2) low-Volume (19-35 patients), 3) high-Volume (36-58 patients), and 4) very high-Volume (59 or more). SETTINGS This study was based on a national inpatient data from the Japanese Diagnosis Procedure Combination database. PATIENTS A total of 7567 patients with colorectal endoscopic submucosal dissection were included. MAIN OUTCOME MEASURES Severe postoperative bleeding requiring endoscopic hemostasis or blood transfusion within 1 week after endoscopic submucosal dissection and perforation requiring open surgery were the main outcomes measured. RESULTS Severe postoperative bleeding and perforation occurred in 331 (4.4%) and 13 patients (0.2%). Multivariable logistic regression analysis showed that the very high Hospital Volume group had a significantly lower proportion of severe postoperative bleeding than the very low Hospital Volume group (OR = 0.48 [95 % CI, 0.27-0.83]; p = 0.009). LIMITATIONS This study lacked some information on clinicopathologic features including en bloc resection, curative resection, and relapse. Individual endoscopist experience could not be analyzed. CONCLUSIONS The present study clearly showed a significant association between higher Hospital Volume and lower occurrence of severe postoperative bleeding.

  • Hospital Volume and cardiac complications of endomyocardial biopsy a retrospective cohort study of 9508 adult patients using a nationwide inpatient database in japan
    Clinical Cardiology, 2015
    Co-Authors: Toshiaki Isogai, Hideo Yasunaga, Hiromasa Horiguchi, Hiroki Matsui, Tetsuro Ueda, Hiroyuki Tanaka, Kiyohide Fushimi
    Abstract:

    Background Recent research on complications with endomyocardial biopsy (EMB) has been based on single-center or 2-center studies in high-Volume cardiovascular centers. No study has examined the association between Hospital Volume and the complication rate after EMB. Hypothesis Hospital Volume is inversely associated with cardiac complication rate after EMB. Methods Using the Diagnosis Procedure Combination database in Japan, we identified inpatients aged ≥20 years who underwent EMB under fluoroscopic guidance. We assessed cardiac complications requiring the following urgent procedures on the day of EMB or the day after: pericardiocentesis, surgical repair, and temporary pacing. Results Among 9508 eligible patients in 491 Hospitals (male, 68%; mean age, 57.0 years), dilated cardiomyopathy was the most frequently diagnosed condition (35.4%). Twenty-four patients (0.25%) required pericardiocentesis on the day of EMB. Three patients (0.03%) underwent surgical repair on the day of EMB or the day after. Sixty-three patients (0.70%) required temporary pacing on the day of EMB. Higher Hospital Volume was associated with lower rates of pericardiocentesis (low Volume, 0.4%; medium Volume, 0.2%; high Volume, 0.1%; P for the trend test, 0.019) and temporary pacing (low Volume, 1.0%; medium Volume, 0.7%; high Volume, 0.2%; P for the trend test, < 0.001). In a multivariable logistic regression analysis, high Hospital Volume was significantly associated with a lower rate of the composite outcome of the procedures (reference, low Volume; adjusted odds ratio, 0.22; 95% confidence interval, 0.08–0.62, P = 0.004). Conclusions Serious cardiac complications of EMB were rare, but higher Hospital Volume was associated with lower complication rate.

John D Birkmeyer - One of the best experts on this subject based on the ideXlab platform.

  • Hospital Volume and operative mortality in the modern era
    Annals of Surgery, 2014
    Co-Authors: Bradley N Reames, John D Birkmeyer, Amir A Ghaferi, Justin B Dimick
    Abstract:

    Objective:To determine whether the relationship between Hospital Volume and mortality has changed over time.Background:It is generally accepted that Hospital Volume is associated with mortality in high-risk procedures. However, as surgical safety has improved over the last decade, recent evidence ha

  • trends in Hospital Volume and operative mortality for high risk surgery
    The New England Journal of Medicine, 2011
    Co-Authors: Jonathan F Finks, Nicholas H Osborne, John D Birkmeyer
    Abstract:

    BACKGROUND There were numerous efforts in the United States during the previous decade to concentrate selected surgical procedures in high-Volume Hospitals. It remains unknown whether referral patterns for high-risk surgery have changed as a result and how operative mortality has been affected. METHODS We used national Medicare data to study patients undergoing one of eight different cancer and cardiovascular operations from 1999 through 2008. For each procedure, we examined trends in Hospital Volume and market concentration, defined as the proportion of Medicare patients undergoing surgery in the top decile of Hospitals by Volume per year. We used regression-based techniques to assess the effects of Volume and market concentration on mortality over time, adjusting for case mix. RESULTS Median Hospital Volumes of four cancer resections (lung, esophagus, pancreas, and bladder) and of repair of abdominal aortic aneurysm (AAA) rose substantially. Depending on the procedure, higher Hospital Volumes were attributable to an increasing number of cases nationwide, an increasing market concentration, or both. Hospital Volumes rose slightly for aortic-valve replacement but fell for coronary-artery bypass grafting and carotid endarterectomy. Operative mortality declined for all eight procedures, ranging from a relative decline of 8% for carotid endarterectomy (1.3% mortality in 1999 and 1.2% in 2008) to 36% for AAA repair (4.4% in 1999 and 2.8% in 2008). Higher Hospital Volumes explained a large portion of the decline in mortality for pancreatectomy (67% of the decline), cystectomy (37%), and esophagectomy (32%), but not for the other procedures. CONCLUSIONS Operative mortality with high-risk surgery fell substantially during the previous decade. Although increased market concentration and Hospital Volume have contributed to declining mortality with some high-risk cancer operations, declines in mortality with other procedures are largely attributable to other factors. (Funded by the National Institute on Aging.).

  • Hospital Volume and operative mortality in cancer surgery a national study
    Archives of Surgery, 2003
    Co-Authors: Emily Finlayson, Philip P Goodney, John D Birkmeyer
    Abstract:

    Background Although initiatives to regionalize cancer surgery are already under way, the relative importance of Volume in cancer surgery is disputed. Hypothesis We examined surgical mortality with 8 cancer resections in the US population to better quantify the influence of Hospital Volume. Methods Using information from the all-payer Nationwide Inpatient Sample (1995-1997), we examined mortality with 8 cancer resections (N = 195 152). After dividing patients into 3 evenly sized Volume groups based on Hospital procedure Volume (low, medium, and high), we used regression techniques to describe relationships between Hospital Volume and in-Hospital mortality, adjusting for patient characteristics. Results Trends toward lower operative risks at high-Volume Hospitals were observed for 7 of the 8 procedures. However, differences between low- and highhigh-Volume Hospitals were statistically significant for only 3 operations (esophagectomy, 15.0% vs 6.5%; pancreatic resection, 13.1% vs 2.5%; and pulmonary lobectomy, 10.1% vs 8.9%, respectively). Although they did not reach statistical significance, absolute differences in mortality between low- and high-Volume Hospitals were greater than 1% for the following 3 procedures: gastrectomy, 8.7% vs 6.9%; cystectomy, 3.6% vs 2.5%; and pneumonectomy, 10.6% vs 8.9%, respectively. Mortality reductions for nephrectomy and colectomy were small. In general, in terms of absolute differences in mortality, the effect of Volume was greatest in elderly patients. Conclusions Operative mortality decreases with increasing Hospital Volume for several cancer resections. However, Volume may be most important in patients who are older and at higher risk.

  • Hospital Volume and Surgical Mortality in the United States
    The New England journal of medicine, 2002
    Co-Authors: John D Birkmeyer, Andrea E. Siewers, Emily Finlayson, Therese A. Stukel, F. Lee Lucas, Ida Batista, H. Gilbert Welch, David E. Wennberg
    Abstract:

    Background Although numerous studies suggest that there is an inverse relation between Hospital Volume of surgical procedures and surgical mortality, the relative importance of Hospital Volume in various surgical procedures is disputed. Methods Using information from the national Medicare claims data base and the Nationwide Inpatient Sample, we examined the mortality associated with six different types of cardiovascular procedures and eight types of major cancer resections between 1994 and 1999 (total number of procedures, 2.5 million). Regression techniques were used to describe relations between Hospital Volume (total number of procedures performed per year) and mortality (in-Hospital or within 30 days), with adjustment for characteristics of the patients. Results Mortality decreased as Volume increased for all 14 types of procedures, but the relative importance of Volume varied markedly according to the type of procedure. Absolute differences in adjusted mortality rates between very-low-Volume Hospitals and very-high-Volume Hospitals ranged from over 12 percent (for pancreatic resection, 16.3 percent vs. 3.8 percent) to only 0.2 percent (for carotid endarterectomy, 1.7 percent vs. 1.5 percent). The absolute differences in adjusted mortality rates between very-low-Volume Hospitals and very-high-Volume Hospitals were greater than 5 percent for esophagectomy and pneumonectomy, 2 to 5 percent for gastrectomy, cystectomy, repair of a nonruptured abdominal aneurysm, and replacement of an aortic or mitral valve, and less than 2 percent for coronary-artery bypass grafting, lower-extremity bypass, colectomy, lobectomy, and nephrectomy. Conclusions In the absence of other information about the quality of surgery at the Hospitals near them, Medicare patients undergoing selected cardiovascular or cancer procedures can significantly reduce their risk of operative death by selecting a high-Volume Hospital.

  • relationship between Hospital Volume and late survival after pancreaticoduodenectomy
    Surgery, 1999
    Co-Authors: John D Birkmeyer, Samuel R G Finlayson, Andrew L Warshaw, Margaret R Grove, Anna N A Tosteson
    Abstract:

    Background: Several studies have reported lower perioperative mortality rates with pancreaticoduodenectomy at high-Volume Hospitals than at low-Volume Hospitals. We sought to determine whether Volume is also related to survival after Hospital discharge. Methods: Using information from the Medicare claims database, we performed a retrospective cohort study of all 7229 patients over age 65 undergoing pancreaticoduodenectomy in the United States between 1992 and 1995. We divided the study population into approximate quartiles according to their Hospital's average annual Volume of pancreaticoduodenectomies in Medicare patients: very low (<1/y), low (1-2/y, medium (2-5/y), and high (5+/y). To adjust for potentially confounding variables, we used a Cox proportional hazards model to examine relationships between Hospital Volume and mortality, our primary outcome measure. Results: Overall, 3-year survival was higher at high-Volume centers (37%) than at medium- (29%), low- (26%), and very low Volume Hospitals (25%) (log-rank P < .0001). After excluding perioperative deaths and adjusting for case-mix, patients undergoing surgery at high-Volume Hospitals remained less likely to experience late mortality than patients at very low Volume centers (adjusted hazard ratio 0.69, 95% CI 0.62-0.76). Relationships between Hospital Volume and survival after discharge were not restricted to patients with cancer diagnoses; patients with benign disease had similar improvements in late survival after surgery at high-Volume centers. Conclusions: Hospital Volume strongly influences both perioperative risk and long-term survival after pancreaticoduodenectomy. Our data suggest that both patient selection and differences in quality of care may underlie better outcomes at high-Volume referral centers. (Surgery 1999;126:178-83.)