Occurrence of Validating Clinical Findings in the Hospital Record for Appendectomy,Cholecystectomy and Intervertebral Disc Excision Patients: Comparisons among Hospitals and among Surgeons

Abstract

This study examines the variation among 36 Pennsylvania hospitals, and the individual surgeons practicing in them, in the proportion of appendectomy, cholecystectomy and intervertebral disc excision patients with clinical findings in the hospital record that validate the need for surgery. Using admissions from January 1990 through June 1991, we performed logistic regressions on the probability of validating clinical findings controlling for patient age, sex, admission severity of illness, and Medicaid and Health Maintenance Organization membership. Our results show that hospitals, and surgeons, vary significantly in their validation rates for cholecystectomy and disc surgery and, to a lesser extent, appendectomy. We also found that increased procedure-specific volume at both the hospital and surgeon levels is not related to the odds of validating clinical findings. We define a future research agenda to investigate the reasons for the observed differences among hospitals and among surgeons.