Interaction of Surgeon Volume and Nurse-to-Patient Ratio on Post-operative Outcomes of Medicare Beneficiaries Following
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ORIGINAL ARTICLE
Interaction of Surgeon Volume and Nurse-to-Patient Ratio on Post-operative Outcomes of Medicare Beneficiaries Following Pancreaticoduodenectomy Anghela Z. Paredes 1 & J. Madison Hyer 1 & Diamantis I. Tsilimigras 1 & Kota Sahara 1 & Susan White 2 & Timothy M. Pawlik 3 Received: 6 August 2019 / Accepted: 25 October 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background We sought to assess the effect of nurse-to-patient ratio on outcomes with a focus on defining whether nurse-topatient ratio altered outcomes relative to pancreaticoduodenectomy (PD) surgeon specific volume. Methods Medicare SAFs from 2013–2015 were used to identify patients who underwent PD. Nurse-to-patient ratio, PD specific surgeon volume were stratified. Association of factors associated with short term outcomes was evaluated. Results Overall, 6668 patients (median age 73, IQR 68–77; 52.8% male) were identified. The median annual PD volume of surgeons in the highest volume tier was 24 (IQR 21–29), whereas surgeons in the lowest tier performed 2 PDs annually (IQR 1–3) (p < 0.001). Compared with hospitals that had the highest nurse-to-patient ratio tier, patients at hospitals with the lowest nurse-topatient ratio tier were 26% more likely to have a complication (OR 1.26, 95% CI 1.02–1.55). Additionally, patients of surgeons in the lowest tier had 43% greater odds of suffering a complication compared to patients of surgeons in the highest tier (OR 1.43, 95% CI 1.11–1.84). However, patients who underwent a PD by a surgeon within the lowest tier had similar odds of a complication irrespective of nurse-to-patient ratio (OR 1.34, 95% CI 0.97–1.86). Conclusion Compared with patients who underwent an operation by a surgeon in highest PD volume tier, patients treated by surgeons in the lowest tier had higher odds of post-operative complications which was not mitigated by a higher nurse-to-patient ratio. Keywords Surgeon volume . Nurse-to-patient ratio . Pancreaticoduodenectomy
Introduction The Institute of Medicine (IOM) has characterized the United States healthcare delivery system as complex and unorganized.1–3 In turn, the IOM has called for the evaluation and reorganization of health microsystems, which are the smallest replicable healthcare units, to improve the quality of care
* Timothy M. Pawlik [email protected] 1
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
2
Division of Health Information Management and Systems, The Ohio State University Wexner Medical Center, Columbus, OH, USA
3
Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH 670, USA
provided to patients.1–3 The surgical team, composed of the surgeon, nurses, and other ancillary medical personnel, represents one of the most dynamic teams in a healthcare organization. In fact, prior research has suggested that mic
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