Cleft-Palate Repair: Does Hospital Case-Volume Impact Outcomes or Cost?

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Abstract

Background:

How hospital case-volume affects operative outcomes and cost continues to grow in importance. The purpose of this study is to examine the relationship of case volume with operative outcomes and cost in cleft palate repair.

Methods:

Subjects undergoing cleft palate repair between 2004 and 2015 were identified in the Pediatric Health Information System (PHIS). Outcomes were compared between two exposure groups, those undergoing treatment at a high-volume institution (>85th percentile; >60 cases per year), and those undergoing treatment at a low-volume institution. Primary outcomes were: any complication, prolonged length of stay, and increased total cost.

Results:

Over twenty thousand patients (N=20,320) from 49 institutions met inclusion criteria. Over one third of subjects underwent palate repair at a high-volume institution (N=7,813, 38.4%). On univariate analysis, these subjects who underwent treatment at a high-volume institution had a lower rate of overall complications (3.4% vs. 5.1%; P<0.001), as well as lower rates of prolonged length of stay (4.5% vs. 5.8%; P<0.001) and increased total cost (48.6% vs. 50.9%; P=0.002). In multivariate regression analyses, subjects treated in high-volume centers were less likely to experience any complication (OR 0.678, p<0.001), and were less likely to have an extended length of stay (OR 0.82, p=0.005). Subjects undergoing palate repair at a high-volume institution were no less likely to incur increased total cost (OR 1.01, p=0.805).

Conclusion:

In institutions performing a high-volume of cleft palate repairs, subjects had significantly decreased odds of experiencing a complication, or prolonged length of stay.

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