The Role of Hospital Transfer in Reexamination Computed Tomography Scans: A Nationwide Cohort Study of Gastric Cancer Patients Undergoing Surgery

Abstract

Because the high-cost of medical imaging can cause a tremendous economic burden across the health care system, we investigated factors associated with taking additional computed tomography (CT) scans. Data of gastric cancer patients were eligible for analysis if the patient underwent a gastrectomy during the study period (2002-2013). We defined initial CT scans as those taken within 90 days from the surgery date. If there was an additional CT scan between the date of an initial CT scan and the surgery date, we regarded it as a reexamination. We used multivariate logistic regression analysis for reexamination CT scans. Among 3342 gastrectomy patients, 1165 participants underwent second CT scans. Transfer experience (adjusted odds ratio (OR) = 23.87, 95% confidence interval (CI) = 18.15-31.39) was associated with higher OR for reexamination. Among transferred patients, an increased number per 100 beds at the initial CT hospital was associated with a decreased OR for reexamination (OR = 0.88, 95% CI = 0.83-0.94), but increased beds in surgery hospitals was related to an increased OR for reexamination (OR = 1.29, 95% CI = 1.20-1.36). In our study, transfer experience, initial CT scan in a low-volume hospital, and surgical treatment in a high-volume hospital were associated with reexamination CT scans.