Impact of merging two university hospitals on surgical outcome after esophagogastric and hepato-pancreato-biliary surgery: Results from a retrospective study

E W Ingwersen; W T Stam; L J van Kesteren; I J A Wissink; M I van Berge Henegouwen; M G Besselink; O R Busch; J I Erdmann; W J Eshuis; S S Gisbertz; G Kazemier; D L van der Peet; R J Swijnenburg; B Zonderhuis; F Daams

doi:10.1016/j.sopen.2023.01.002

Impact of merging two university hospitals on surgical outcome after esophagogastric and hepato-pancreato-biliary surgery: Results from a retrospective study

Surg Open Sci. 2023 Jan 24:12:1-8. doi: 10.1016/j.sopen.2023.01.002. eCollection 2023 Mar.

Authors

E W Ingwersen^{1

2}, W T Stam^{1

2}, L J van Kesteren¹, I J A Wissink^{3

4}, M I van Berge Henegouwen^{2

5}, M G Besselink^{2

5}, O R Busch^{2

5}, J I Erdmann^{2

5}, W J Eshuis^{2

5}, S S Gisbertz^{2

5}, G Kazemier^{1

2}, D L van der Peet^{1

2}, R J Swijnenburg^{2

5}, B Zonderhuis^{1

2}, F Daams^{1

2}

Affiliations

¹ Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
² Cancer Center Amsterdam, the Netherlands.
³ Division of Infectious Diseases, Department of Medicine, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
⁴ Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
⁵ Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.

Abstract

Background: Due to centralization and super-specialization in medicine, hospital mergers are increasingly common. Their effect on postoperative outcomes in highly specialized surgical departments is unclear. As quality metrics often worsen after major organizational changes, preservation of quality of care during an hospital merge is of the utmost importance.

Objective: To evaluate the effect of a merger of two Dutch university hospitals on quality of surgical care, volume, and timeliness of care.

Methods: The upper gastro-intestinal and hepato-biliary-pancreatic sections merged on the 27th of January 2020 and the 31th of May 2021 respectively. Outcomes of all adult surgical patients were compared six months before and six months after the merger. Short-term quality metrics, volume, and timeliness of care were assessed.

Results: Overall, a cohort of 631 patients were included of whom 195 were upper gastro-intestinal (97 prior to the merger, 98 after the merger) and 436 (223 prior to the merger, 213 after) hepato-biliary-pancreatic patients. There were no differences in mortality, readmission, number and severity of complications, volume, and timeliness of care six months post-merger as compared to before merger.

Conclusion: This study shows that a hospital merger of two university hospitals can be performed without jeopardizing patient safety and while benefitting from centralization of highly specialized care and enhancement of medical research.

Key message: This study investigated the impact of a merger of two Dutch university hospitals on quality of care, timeliness of care, and volume. It showed no deterioration in the evaluated short-term quality metrics, volume or timeliness for upper GI and HPB surgery, suggesting that a hospital merger of two university hospitals can be performed safely, while benefitting from centralization of highly specialized care and enhancement of medical research.

Keywords: AMC, Academic Medical Center; Complications; GI, gastrointestinal; HPB, hepato-biliary-pancreatic; Hepato-biliary-pancreatic; Merge; QoC, Quality of Care; Quality of care; University centers; Upper gastrointestinal; VUmc, Free Univeristy Medical Center.