Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries

Background: We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS. Methods: Using Taiwan's national data (2001–2012), we conducted a retrospective cohort study of all adults 18–64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day. Results: Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11–1.55) and high-volume surgeons (OR = 1.16; CI,1.03–1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small. Conclusions: There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October 2017. Received for publication April 4, 2017; accepted August 21,2017. Disclosure: Supported by the Plastic Surgery Foundation National Endowment for Plastic Surgery Grant (to Dr. Elham Mahmoudi), a Midcareer Investigator Award in Patient-Oriented Research from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (2 K24-AR053120-06) (to Dr. Kevin C. Chung), and The Integration and Maintenance Program of Health Information Application and Collaborative Research Award (to Drs. Ming-Huei Cheng and Chee-Jen Chang) (CIRPD1D0032). The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Elham Mahmoudi, PhD, University of Michigan North Campus Research Complex, 2800 Plymouth Rd Building 16, Room G024W, Ann Arbor, MI 48109, E-mail: Mahmoudi@med.umich.edu Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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