Impact of hospital volume and specialization on the cost of orbital trauma care.

Abstract

To examine the impact of hospital volume and specialization on the cost of orbital trauma care. Comparative case series and database study. Four hundred ninety-nine patients who underwent orbital reconstruction at either a high-volume regional eye trauma center, its academic parent institution, or all other hospitals in Maryland between 2004 and 2009. We used a publicly available database of hospital discharge data to identify the study population's clinical and cost characteristics. Multivariate models were developed to determine the impact of care setting on hospital costs while controlling for patient demographic and clinical variables. Mean hospital costs accrued during hospital admission for orbital reconstruction in 3 separate care settings. Almost half (n = 248) of all patients received surgical care at the regional eye trauma center and had significantly lower adjusted mean hospital costs ($6194; 95% confidence interval [CI], $5709-$6719) compared with its parent institution ($8642; 95% CI, $7850-$9514) and all other hospitals ($12,692; 95% CI, $11,467-$14,047). A subpopulation analysis selecting patients with low comorbidity scores also was performed. The eye trauma center continued to have lower adjusted costs ($4277; 95% CI, $4112-$4449) relative to its parent institution ($6595; 95% CI, $5838-$7451) and other hospitals ($7150; 95% CI, $5969-$8565). Higher volume and specialization seen at a regional eye trauma center are associated with lower costs in the surgical management of orbital trauma.