Background
Our objective was to determine the hospital resources required for low-volume, high-quality
care at high-volume cancer resection centers.
Methods
Patients who underwent esophageal, pancreatic, and rectal resection for malignancy
were identified using Healthcare Cost and Utilization Project State Inpatient Database
(Florida and California) between 2007 and 2011. Annual case volume by procedure was
used to identify high- and low-volume centers. Hospital data were obtained from the
American Hospital Association Annual Survey Database. Procedure risk-adjusted mortality
was calculated for each hospital using multilevel, mixed-effects models.
Results
A total of 24,784 patients from 302 hospitals met the inclusion criteria. Of these,
13 hospitals were classified as having a high-volume, oncologic resection ecosystem
by being a high-volume hospital for ≥2 studied procedures. A total of 11 of 31 studied
hospital factors were strongly associated with hospitals that performed a high volume
of cancer resections and were used to develop the High Volume Ecosystem for Oncologic
Resections (HIVE-OR) score. At low-volume centers, increasing HIVE-OR score resulted
in decreased mortality for rectal cancer resection (P = .038). HIVE-OR was not related to risk-adjusted mortality for esophagectomy (P = .421) or pancreatectomy (P = .413) at low-volume centers.
Conclusion
Our study found that in some settings, low-volume, high-quality cancer surgical care
can be explained by having a high-volume ecosystem.
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Article info
Publication history
Published online: August 11, 2016
Accepted:
July 4,
2016
Footnotes
Supported by National Institutes of Health grant T32 GM08750-16.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
