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.
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Article info
Publication history
Published online: August 30, 2016
Accepted:
July 23,
2016
Footnotes
Dr Liu is supported by a research fellowship from the Department of Surgery, University of Chicago Hospitals, and the American College of Surgeons Clinical Scholars in Residence Program.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
