Hospital characteristics, rather than surgical volume, predict length of stay following colorectal cancer surgery

D Vicendese, L Te Marvelde, PD McNair, K Whitfield, DR English, S Ben Taieb, RJ Hyndman, R Thomas
(2019) Australian and New Zealand Journal of Public Health, to appear

DOI

Objective

Length of hospital stay (LOS) is considered a vital component for successful colorectal surgery treatment. Evidence of an association between hospital surgery volume and LOS has been mixed. Data modelling techniques may adversely impact conclusions to the extent of reversing them. This study applied techniques to overcome possible drawbacks.

Method

An additive quantile regression model formulated to isolate hospital contextual effects was applied to every colorectal surgery for cancer conducted in Victoria Australia between 2005 and 2015: 28,343 admissions in 90 Victorian hospitals. The model compared hospitals’ operational efficiencies regarding LOS.

Results

Hospital LOS operational efficiencies for colorectal cancer surgery varied markedly between the 90 hospitals and were independent of volume. This result was adjusted for pertinent patient and hospital characteristics.

Conclusion

No evidence was found that higher annual surgery volume was associated with lower LOS for patients undergoing colorectal cancer surgery. Our model showed strong evidence that differences in LOS efficiency between hospitals was driven by hospital contextual effects which were not predicted by provider volume. Further study is required to elucidate these inherent differences between hospitals.

Implications for Public Health

Our model indicated improved efficiency would benefit the patient and medical system by lowering LOS and reducing expenditure by over $3 million per year.