Patient characteristics associated with undergoing cancer operations at low-volume hospitals

Background Although strong volume-outcome relationships exist for many cancer operations, patients continue to undergo these operations at low-volume hospitals. Methods Patients were identified from the National Cancer Data Base from 2010–2013 who underwent resection for bladder, breast, esophagus,...

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Bibliographic Details
Published in:Surgery 2017-02, Vol.161 (2), p.433-443
Main Authors: Liu, Jason B., MD, Bilimoria, Karl Y., MD, MS, FACS, Mallin, Katherine, PhD, Winchester, David P., MD, FACS
Format: Article
Language:English
Subjects:
Aged
Cohort Studies
Databases, Factual
Disease-Free Survival
Female
Hospital Mortality - trends
Hospitals, Low-Volume - utilization
Humans
Logistic Models
Male
Middle Aged
Needs Assessment
Neoplasms - mortality
Neoplasms - pathology
Neoplasms - surgery
Outcome Assessment (Health Care)
Postoperative Complications - mortality
Postoperative Complications - physiopathology
Retrospective Studies
Risk Assessment
Socioeconomic Factors
Surgery
Surgical Procedures, Operative - methods
Surgical Procedures, Operative - mortality
Survival Rate
United States
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Summary:Background Although strong volume-outcome relationships exist for many cancer operations, patients continue to undergo these operations at low-volume hospitals. Methods Patients were identified from the National Cancer Data Base from 2010–2013 who underwent resection for bladder, breast, esophagus, lung, pancreas, rectum, and stomach cancers. Low-volume hospitals were defined as those in the bottom quartile by surgical volume for each cancer type separately. Logistic regression models were constructed to assess patient-level factors associated with undergoing cancer surgery at low-volume hospitals across cancer types while controlling for tumor characteristics. Survival outcomes (30- and 90-day mortality; overall survival) were also assessed. Results Low volume thresholds were 4, 84, 4, 18, 8, 7, and 4 resections per year for bladder, breast, esophagus, lung, pancreas, rectum, and stomach cancers, respectively, resulting in 772 (74.1%), 828 (57.5%), 664 (77.5%), 830 (64.7%), 716 (79.2%), 898 (65.1%), and 888 (68.5%) hospitals classified as low-volume hospitals, respectively. For all the cancers examined, patients were more likely to undergo operation at low-volume hospitals if they traveled shorter distances (home to surgical facility), resided in rural locations, or had not received neoadjuvant therapy. Other patient and tumor factors were not associated consistently with undergoing operation at low-volume hospitals. Patients who went to low-volume hospitals had poorer outcomes among the studied cancers. Conclusion Patients continue to undergo operation at low-volume hospitals due to where they live and how far they have to travel. Regionalization policy initiatives will remain challenging in this population. Efforts should therefore continue to emphasize quality improvement locally at each facility caring for patients with cancer.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2016.07.027