Abstract Date: 5/2/2015
Kristopher Kimmell, MD
Peter Salzman, PhD
Matthew Miller, MD
Laura Calvi, MD
George Vates, MD, PhD (Rochester, NY)
Surgeon volume and experience affect complications and length of stay. We examined the relationship between surgeon volume and variation in hospital cost and charges across New York State for transsphenoidal pituitary surgery.
Using the HCUP State Inpatient Database for New York, we performed surgeon volume-cost analysis on pituitary tumor surgery from 2008 to 2011. All patients underwent elective pituitary tumor surgery and were discharged to home or self-care. Surgeons who performed less than 20 cases per year were compared to surgeons who performed 20 or more cases per year on hospital charges, costs, cost-to-charge ratios, and length of stay (LOS).
1,803 transsphenoidal pituitary tumor surgeries were performed in New York State. Patient mean age was 50.7 years (54% female). Median hospital charge and cost for surgeons with less than 20 cases per year was $47,800 and $15,600, respectively. Median hospital charge and cost of surgeons with 20 or more cases per year was $28,200 and $10,500. The cost-to-charge ratios for surgeons with less than 20 cases per year were lower than that of surgeons with 20 or more cases per year, suggesting charge “inflation.” Median LOS for surgeons with less than 20 cases per year and surgeons with 20 or more cases per year were 3 days and 2 days, respectively.
Within New York State, experienced pituitary neurosurgeons demonstrated decreased hospital charges, costs, and length of stay. These data suggest that patients with pituitary tumors (a highly portable disease) should be considered for referral to high volume surgeons to promote high value, effective care.
Article ID: AA-31538