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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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| Published in: | Surgery 2017-02, Vol.161 (2), p.433-443 |
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| container_title | Surgery |
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| creator | Liu, Jason B., MD Bilimoria, Karl Y., MD, MS, FACS Mallin, Katherine, PhD Winchester, David P., MD, FACS |
| description | 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. |
| doi_str_mv | 10.1016/j.surg.2016.07.027 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1859716930</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0039606016304020</els_id><sourcerecordid>1859716930</sourcerecordid><originalsourceid>FETCH-LOGICAL-c481t-b41e455e9833b6abca6576dfbe63328a1a75ea91d1cb3d7d5462060243778bec3</originalsourceid><addsrcrecordid>eNp9kU2LFDEQhoMo7rj6BzxIH710W0m6k24QQRa_YEFBvQkhndTMZOzpjKn0LvvvTTOrBw-eqg7P-0I9xdhzDg0Hrl4dGlrSrhFlb0A3IPQDtuGdFLWWij9kGwA51AoUXLAnRAcAGFreP2YXQncDKK437McXmwPOuXJ7m6zLmALl4KiyRNEFm9FXtyHvq2X2mHYxzLvK2dlhquIJUwnHucC5muJtfROn5YjVPtIpZDvRU_ZoWwY-u5-X7Pv7d9-uPtbXnz98unp7Xbu257keW45t1-HQSzkqOzqrOq38dkQlpegtt7pDO3DP3Si99l2rRDlKtFLrfkQnL9nLc-8pxV8LUjbHQA6nyc4YFzK87wbN1SChoOKMuhSJEm7NKYWjTXeGg1mtmoNZrZrVqgFtitUSenHfv4xH9H8jfzQW4PUZwHLlTcBkyBWrDn1I6LLxMfy__80_cTeFOTg7_cQ7pENc0lz8GW5IGDBf17-ub-VKQgsC5G_3v59j</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1859716930</pqid></control><display><type>article</type><title>Patient characteristics associated with undergoing cancer operations at low-volume hospitals</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>Liu, Jason B., MD ; Bilimoria, Karl Y., MD, MS, FACS ; Mallin, Katherine, PhD ; Winchester, David P., MD, FACS</creator><creatorcontrib>Liu, Jason B., MD ; Bilimoria, Karl Y., MD, MS, FACS ; Mallin, Katherine, PhD ; Winchester, David P., MD, FACS</creatorcontrib><description>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.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2016.07.027</identifier><identifier>PMID: 27590617</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>Surgery, 2017-02, Vol.161 (2), p.433-443</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-b41e455e9833b6abca6576dfbe63328a1a75ea91d1cb3d7d5462060243778bec3</citedby><cites>FETCH-LOGICAL-c481t-b41e455e9833b6abca6576dfbe63328a1a75ea91d1cb3d7d5462060243778bec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27590617$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Jason B., MD</creatorcontrib><creatorcontrib>Bilimoria, Karl Y., MD, MS, FACS</creatorcontrib><creatorcontrib>Mallin, Katherine, PhD</creatorcontrib><creatorcontrib>Winchester, David P., MD, FACS</creatorcontrib><title>Patient characteristics associated with undergoing cancer operations at low-volume hospitals</title><title>Surgery</title><addtitle>Surgery</addtitle><description>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.</description><subject>Aged</subject><subject>Cohort Studies</subject><subject>Databases, Factual</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hospital Mortality - trends</subject><subject>Hospitals, Low-Volume - utilization</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Needs Assessment</subject><subject>Neoplasms - mortality</subject><subject>Neoplasms - pathology</subject><subject>Neoplasms - surgery</subject><subject>Outcome Assessment (Health Care)</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Socioeconomic Factors</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative - methods</subject><subject>Surgical Procedures, Operative - mortality</subject><subject>Survival Rate</subject><subject>United States</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kU2LFDEQhoMo7rj6BzxIH710W0m6k24QQRa_YEFBvQkhndTMZOzpjKn0LvvvTTOrBw-eqg7P-0I9xdhzDg0Hrl4dGlrSrhFlb0A3IPQDtuGdFLWWij9kGwA51AoUXLAnRAcAGFreP2YXQncDKK437McXmwPOuXJ7m6zLmALl4KiyRNEFm9FXtyHvq2X2mHYxzLvK2dlhquIJUwnHucC5muJtfROn5YjVPtIpZDvRU_ZoWwY-u5-X7Pv7d9-uPtbXnz98unp7Xbu257keW45t1-HQSzkqOzqrOq38dkQlpegtt7pDO3DP3Si99l2rRDlKtFLrfkQnL9nLc-8pxV8LUjbHQA6nyc4YFzK87wbN1SChoOKMuhSJEm7NKYWjTXeGg1mtmoNZrZrVqgFtitUSenHfv4xH9H8jfzQW4PUZwHLlTcBkyBWrDn1I6LLxMfy__80_cTeFOTg7_cQ7pENc0lz8GW5IGDBf17-ub-VKQgsC5G_3v59j</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Liu, Jason B., MD</creator><creator>Bilimoria, Karl Y., MD, MS, FACS</creator><creator>Mallin, Katherine, PhD</creator><creator>Winchester, David P., MD, FACS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170201</creationdate><title>Patient characteristics associated with undergoing cancer operations at low-volume hospitals</title><author>Liu, Jason B., MD ; Bilimoria, Karl Y., MD, MS, FACS ; Mallin, Katherine, PhD ; Winchester, David P., MD, FACS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-b41e455e9833b6abca6576dfbe63328a1a75ea91d1cb3d7d5462060243778bec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Cohort Studies</topic><topic>Databases, Factual</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hospital Mortality - trends</topic><topic>Hospitals, Low-Volume - utilization</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Needs Assessment</topic><topic>Neoplasms - mortality</topic><topic>Neoplasms - pathology</topic><topic>Neoplasms - surgery</topic><topic>Outcome Assessment (Health Care)</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - physiopathology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Socioeconomic Factors</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative - methods</topic><topic>Surgical Procedures, Operative - mortality</topic><topic>Survival Rate</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Jason B., MD</creatorcontrib><creatorcontrib>Bilimoria, Karl Y., MD, MS, FACS</creatorcontrib><creatorcontrib>Mallin, Katherine, PhD</creatorcontrib><creatorcontrib>Winchester, David P., MD, FACS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Jason B., MD</au><au>Bilimoria, Karl Y., MD, MS, FACS</au><au>Mallin, Katherine, PhD</au><au>Winchester, David P., MD, FACS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient characteristics associated with undergoing cancer operations at low-volume hospitals</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>161</volume><issue>2</issue><spage>433</spage><epage>443</epage><pages>433-443</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27590617</pmid><doi>10.1016/j.surg.2016.07.027</doi><tpages>11</tpages></addata></record> |
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| 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 |
| title | Patient characteristics associated with undergoing cancer operations at low-volume hospitals |
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