Tumor Reconstruction & Limb Salvage Journal Scan

Impact of hospital volume on postoperative complications and in-hospital mortality after musculoskeletal tumor surgery: analysis of a national administrative database.

J Bone Joint Surg Am. 2013 Sep 18;95(18):1684-91

Authors: Ogura K, Yasunaga H, Horiguchi H, Ohe K, Shinoda Y, Tanaka S, Kawano H

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