• Sahil Gambhir, Shaun Daly, Areg Grigorian, Sarath Sujtha-Bhaskar, Colette S Inaba, Marcelo W Hinojosa, Brian R Smith, and Ninh T Nguyen.
• Department of Surgery, University of California Irvine Medical Center, Orange, California.
• JAMA Surg. 2019 Sep 1; 154 (9): 861-866.

ImportanceThe US News & World Report (USNWR) annual ranking of the best hospitals for gastroenterology and gastrointestinal operations provides guidance and referral of care for medical and surgical gastrointestinal conditions.ObjectiveTo investigate whether USNWR top-ranked hospitals for gastroenterology and gastrointestinal surgical procedures are associated with improvements in patient outcomes, compared with nonranked hospitals, in common advanced laparoscopic abdominal operations.Design, Setting, And ParticipantsThis study used the Vizient database, which contains administrative, clinical, and financial inpatient information of index hospitalizations for US academic centers and their affiliated hospitals that are members of Vizient. Data were obtained on advanced laparoscopic abdominal operations performed from January 1, 2017, through December 31, 2017, at USNWR top-ranked hospitals (n = 16 296 operations) and nonranked hospitals (n = 35 573 operations). Abdominal operations included bariatric, colorectal, and hiatal hernia procedures. Operations on patients younger than 18 years, emergent cases, conversion cases, and patients with extreme severity of illness were excluded.Main Outcomes And MeasuresOutcome measures included in-hospital mortality, mortality index (observed to expected mortality ratio), serious morbidity, length of stay, and cost.ResultsA total of 51 869 advanced laparoscopic abdominal operations were performed at 351 academic health centers and their community affiliates. Of these procedures, 16 296 (31.4%) were performed at 41 top-ranked hospitals and 35 573 (68.6%) at 310 nonranked hospitals. The annual case volume at top-ranked hospitals was 397 compared with 114 at nonranked hospitals. Between top-ranked and nonranked hospitals, no significant differences were found in in-hospital mortality (0.04% vs 0.07%; P = .33) or serious morbidity (1.06% vs 1.02%; P = .75). Compared with nonranked hospitals, advanced laparoscopic abdominal operations performed at top-ranked hospitals had higher mean costs ($7128 [$4917] vs $7742 [$6787]; P < .01) and longer mean lengths of stay (2.38 [2.60] days vs 2.73 [3.31] days; P < .01).Conclusions And RelevanceAlthough, among academic centers, the annual volume of advanced laparoscopic abdominal operations was 3-fold higher for USNWR top-ranked hospitals compared with nonranked hospitals, the volume did not appear to be associated with improved patient outcomes.

28 keywords...

hide…