Impact of hospital volume effect on patient safety indicator event occurrence and on failure to rescue (death after patient safety indicator event) from individual multivariable logistic regression models adjusted for hospital clustering by generalised estimating equation in patients undergoing major cancer surgery, Nationwide Inpatient Sample, 1999–2009
| Patient safety indicator occurrence* | Failure to rescue* | |||
|---|---|---|---|---|
| Procedure | OR (95% CI) | p Value | OR (95% CI) | p Value |
| Overall | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 0.945 (0.922 to 0.969) | <0.001 | 0.920 (0.861 to 0.982) | 0.013 |
| 3rd volume quartile | 0.883 (0.860 to 0.907) | <0.001 | 0.842 (0.784 to 0.904) | <0.001 |
| 4th volume quartile | 0.761 (0.739 to 0.783) | <0.001 | 0.716 (0.661 to 0.775) | <0.001 |
| Colectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 1.007 (0.969 to 1.046) | 0.728 | 1.029 (0.936 to 1.132) | 0.553 |
| 3rd volume quartile | 0.940 (0.902 to 0.980) | 0.003 | 0.978 (0.883 to 1.083) | 0.670 |
| 4th volume quartile | 0.842 (0.805 to 0.881) | <0.001 | 0.831 (0.742 to 0.931) | 0.001 |
| Cystectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 0.816 (0.728 to 0.914) | <0.001 | 0.872 (0.642 to 1.185) | 0.382 |
| 3rd volume quartile | 0.760 (0.672 to 0.860) | <0.001 | 0.691 (0.487 to 0.981) | 0.039 |
| 4th volume quartile | 0.585 (0.509 to 0.671) | <0.001 | 0.706 (0.471 to 1.058) | 0.092 |
| Oesophagectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 0.802 (0.653 to 0.986) | 0.037 | 0.633 (0.432 to 0.928) | 0.019 |
| 3rd volume quartile | 0.687 (0.546 to 0.863) | 0.001 | 0.488 (0.309 to 0.770) | 0.002 |
| 4th volume quartile | 0.479 (0.378 to 0.609) | <0.001 | 0.459 (0.280 to 0.753) | 0.002 |
| Gastrectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 1.043 (0.935 to 1.163) | 0.455 | 1.028 (0.820 to 1.289) | 0.812 |
| 3rd volume quartile | 0.973 (0.866 to 1.093) | 0.642 | 0.847 (0.660 to 1.088) | 0.193 |
| 4th volume quartile | 0.905 (0.795 to 1.030) | 0.129 | 0.709 (0.532 to 0.945) | 0.019 |
| Hysterectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 1.044 (0.930 to 1.172) | 0.468 | 0.955 (0.895 to 1.020 | 0.168 |
| 3rd volume quartile | 1.264 (1.118 to 1.428) | <0.001 | 0.874 (0.815 to 0.938) | <0.001 |
| 4th volume quartile | 1.231 (1.083 to 1.399) | 0.001 | 0.758 (0.701 to 0.820) | <0.001 |
| Lung | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 0.954 (0.911 to 1.000) | 0.048 | 0.820 (0.720 to 0.934) | 0.003 |
| 3rd volume quartile | 0.910 (0.866 to 0.956) | <0.001 | 0.755 (0.657 to 0.867) | <0.001 |
| 4th volume quartile | 0.792 (0.750 to 0.836) | <0.001 | 0.643 (0.548 to 0.753) | <0.001 |
| Pancreatectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 0.767 (0.676 to 0.870) | <0.001 | 0.598 (0.460 to 0.775) | <0.001 |
| 3rd volume quartile | 0.539 (0.468 to 0.621) | <0.001 | 0.405 (0.291 to 0.564) | <0.001 |
| 4th volume quartile | 0.416 (0.357 to 0.485) | <0.001 | 0.362 (0.250 to 0.525) | <0.001 |
| Prostatectomy | ||||
| 1st volume quartile | 1.0 (ref.) | – | 1.0 (ref.) | – |
| 2nd volume quartile | 0.772 (0.713 to 0.837) | <0.001 | 1.293 (0.696 to 2.403) | 0.415 |
| 3rd volume quartile | 0.736 (0.673 to 0.805) | <0.001 | 1.335 (0.687 to 2.591) | 0.394 |
| 4th volume quartile | 0.541 (0.488 to 0.600) | <0.001 | 0.293 (0.085 to 1.006) | 0.051 |
*Multivariable models were generated for the overall model and for each procedure individually. Only the OR and 95% CI for hospital volume are displayed in the table. Other covariates in each model included: age, gender, race, comorbidities, median household income by ZIP code, hospital location, teaching status, region, year of admission and procedure type (for overall model only).