Association between surgeon volume and hospitalisation costs for patients with oral cancer: a nationwide population base study in Taiwan.

OBJECTIVE

Oral cancer leads to a considerable use of and expenditure on health care. Wide resection of the tumour and reconstruction with a pedicle flap/free flap is widely used. This study was conducted to explore the relationship between hospitalisation costs and surgeon case volume when this operation was performed.

SETTING

A population-based study.

DESIGN

This study uses data for the years 2005-2006 obtained from the National Health Insurance Research Database published in the Taiwanese National Health Research Institute.

PARTICIPANTS

From this population-based data, the authors selected a total of 2663 oral cancer patients who underwent tumour resection and reconstruction.

MAIN OUTCOME MEASURES

Case volume relationships were based on the following criteria; low-, medium-, high-, very high-volume surgeons were defined by <or= 9, 10-29, 30-55, >or= 56 resections with reconstruction, respectively. Hierarchical linear regression analysis was subsequently performed to explore the relationship between surgeon case volume and the cost and length of hospitalisation.

RESULTS

The mean hospitalisation cost among the 2663 patients was US$ 9528 (all costs are given in US dollars). After adjusting for physician, hospital, and patient characteristics in a hierarchical linear regression model, the cost per patient for low-volume surgeons was found to be US$ 741 (P = 0.012) higher than that for medium-volume surgeons, US$ 1546 (P < 0.001) higher than that for high-volume surgeons, and US$ 1820 (P < 0.001) higher than that for very-high-volume surgeons. After adjustment for physician, hospital, and patient characteristics, the hierarchical linear regression model revealed that the mean length of stay per patient for low-volume surgeons was the highest (P < 0.001).

CONCLUSIONS

After adjustment for physician, hospital, and patient characteristics, low-volume surgeons performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher costs and longer hospital stays per patient than did other surgeons. Treatment strategies adopted by high- and very-high-volume surgeons should be analysed further and utilised more widely.