High-Quality, Low-Cost Gastrectomy Care at High-Volume Hospitals Results From a Population-Based Study in South Korea

Objectives: To evaluate associations among hospital volume, costs, and length of stay (LOS) and to assess whether reduced hospital cost of care adversely affected quality of care. Design: Four-year, nationwide, population-based study. Setting: Data were obtained from claims submitted to the South Korean National Health Insurance database. Patients: We identified 48 938 patients at 274 hospitals who had undergone gastric resection from January 1, 2002, through December 31, 2005. Hospital volumes were divided into quartiles. Main Outcome Measures: Patient demographics and socioeconomic and clinical variables were investigated as factors that might affect costs and LOS. Results: Independent predictors of higher costs and longer LOS included older age, increased Charlson score, and hospitals with fewer beds. After adjusting for relevant factors, an inverse relationship between volume and costs or LOS was found such that higher-volume hospitals had the lowest procedure costs and LOS. Results showed no association between hospital cost and quality of care. Conclusions: Higher hospital volume is predictive of lower costs and LOS for patients undergoing gastric resection. By referring these patients to high-volume centers, we may improve quality of care and reduce costs. Furthermore, high-quality care can be maintained when costs are lowered due to high volume.