“Hub,” “spoke” hospital care inefficiencies differ depending on surgical complexity

Editor's Note:

Complex surgeries at high-volume (“hub”) hospitals are less likely to result in death or serious morbidity (DSM) than other hospitals within a system (“spokes”), the American Journal of Surgery reported December 25. However, patients undergoing common surgical care procedures at hubs are more likely to experience prolonged length of stay (LOS), with no relative benefit to the odds of DSM.

The study, which used risk-adjusted logistic regression to estimate the odds of DSM and LOS, involved 122,895 patients across 43 hub-and-spoke systems in 13 states. Hubs completed 83.2 ​% of complex and 59.6 ​% of common operations. For complex operations, odds of DSM were significantly lower in hubs (OR: 0.80; 95 ​% CI [0.65, 0.98]). For common operations, odds of DSM were similar between hubs and spokes, while odds of prolonged LOS were greater at hubs (OR 1.19; 95 ​% CI [1.16,1.24]).

Researchers note the findings present opportunities for improving system efficiency.