Association of social vulnerability with the use of high-volume and Magnet recognition hospitals for hepatopancreatic cancer surgery

Surgery ◽  
2021 ◽  
Author(s):  
Adrian Diaz ◽  
J. Madison Hyer ◽  
Rosevine Azap ◽  
Diamantis Tsilimigras ◽  
Timothy M. Pawlik
Keyword(s):  
Social Vulnerability ◽  
High Volume ◽  
Cancer Surgery ◽  
Magnet Recognition

The effects of centralizing cancer surgery on postoperative mortality: A systematic review and meta-analysis

2021 ◽  
pp. 135581962110089
Author(s):  
Roberto Grilli ◽  
Federica Violi ◽  
Maria Chiara Bassi ◽  
Massimiliano Marino
Keyword(s):  
Evaluation Studies ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Interrupted Time Series ◽  
High Volume ◽  
Cancer Surgery ◽  
Interrupted Time Series Analysis ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
After Cancer

Objectives To review the evidence of the effects of centralization of cancer surgery on postoperative mortality. Methods We searched Medline, Embase, Cinahl, Cochrane and Scopus (up to November 2019) for studies that (i) assessed the effects of centralization of cancer surgery policies on in-hospital or 30-day mortality, or (ii) described changes in both postoperative mortality for a surgical intervention and degree of centralization using reduction in the number of hospitals or increases in the proportion of patients undergoing cancer surgery at high volume hospitals as proxy. PRISMA guidelines were followed. We estimated pooled odds ratios (OR) and conducted meta-regression to assess the relationship between degree of centralization and mortality. Results A total of 41 studies met our inclusion criteria of which 15 evaluated the effect of centralization policies on postoperative mortality after cancer surgery and 26 described concurrent changes in the degree of centralization and postoperative mortality. Policy evaluation studies mainly used before-after designs (n = 13) or interrupted time series analysis (n = 2), mainly focusing on pancreatic, oesophageal and gastric cancer. All but one showed some degree of reduction in postoperative mortality, with statistically significant effects demonstrated by six studies. The pooled odds ratio for centralization policy effect was 0.68 (95% Confidence interval: 0.54–0.85; I2 = 80%). Meta-regression analysis of the 26 descriptive studies found that an increase of the proportion of patients treated at high volume hospitals was associated with greater reduction in postoperative mortality. Conclusions Centralization of cancer surgery is associated with reduced postoperative mortality. However, existing evidence tends to be of low quality and estimates of the effect size are likely inflated. There is a need for prospective studies using more robust approaches, and for centralization efforts to be accompanied by well-designed evaluations of their effectiveness.

scholarly journals Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery

2021 ◽  
Author(s):  
Miriam Lillo-Felipe ◽  
Rebecka Ahl Hulme ◽  
Maximilian Peter Forssten ◽  
Gary A. Bass ◽  
Yang Cao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
High Volume ◽  
Cancer Surgery ◽  
Colon And Rectal Surgery ◽  
Surgical Volume ◽  
Failure To Rescue ◽  
Colorectal Cancer Surgery ◽  
Procedure Volume ◽  
Low Volume

Abstract Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

Racial and Socioeconomic Differences in the Use of High-Volume Commission on Cancer-Accredited Hospitals for Cancer Surgery in the United States

2018 ◽  
Vol 25 (5) ◽  
pp. 1116-1125 ◽  
Author(s):  
Nabil Wasif ◽  
David Etzioni ◽  
Elizabeth B. Habermann ◽  
Amit Mathur ◽  
Barbara A. Pockaj ◽  
...  
Keyword(s):  
United States ◽  
High Volume ◽  
The United States ◽  
Cancer Surgery ◽  
Socioeconomic Differences

Creating an online resource providing hospital cancer surgery volumes in California.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 172-172
Author(s):  
Christina A Clarke ◽  
Laurence C Baker ◽  
Jennifer Malin ◽  
Joseph Parker ◽  
Merry Holliday-Hanson ◽  
...  
Keyword(s):  
Health Planning ◽  
Public Information ◽  
High Volume ◽  
Median Number ◽  
Cancer Surgery ◽  
Sufficient Evidence ◽  
Cancer Site ◽  
Volume Data ◽  
Volume Calculation ◽  
Low Volume

172 Background: Little evidence is available to help patients and providers, payers and policymakers find the highest-quality hospitals for cancer surgery. We initiated a groundbreaking effort in California ( www.calqualitycare.org ) to publicly report hospital cancer surgery volume data online. Methods: With financial support from the nonprofit California HealthCare Foundation, we assembled a multidisciplinary team to oversee the project and ensure sound methodology. We obtained existing hospital discharge summary data from the California Office of Statewide Health Planning and Development (OSHPD). We selected cancer surgeries eligible for display through comprehensive review of the literature addressing the association of hospital volume and mortality. We found eleven cancer sites with sufficient evidence of association including bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach. Experts advised volume calculation and display of results. Leaders of low volume hospitals were interviewed to understand the reasons for low volume. Results: In 2014, about 60% of cancer surgeries in California were performed at hospitals in the top 20% of volume, but many hospitals performed low numbers of complex procedures, with the per hospital median number of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries at 4 or less. Low-volume hospitals included rural and urban hospitals, with small and large bed sizes, and teaching and non-teaching status. At least 670 Californians received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer site; 72% of those patients lived within 50 miles of a top-20% volume hospital. Conclusions: This project demonstrates the potential for public information about hospital volumes to point patients towards high-volume and away from low-volume hospitals. Data regarding 2014 volumes are now available online.

scholarly journals Temporal trends in centralization and racial disparities in utilization of high-volume hospitals for lung cancer surgery

Medicine ◽  
2017 ◽  
Vol 96 (16) ◽  
pp. e6573 ◽  
Author(s):  
Wil Lieberman-Cribbin ◽  
Bian Liu ◽  
Emanuele Leoncini ◽  
Raja Flores ◽  
Emanuela Taioli
Keyword(s):  
Lung Cancer ◽  
Racial Disparities ◽  
Temporal Trends ◽  
Lung Cancer Surgery ◽  
High Volume ◽  
Cancer Surgery

scholarly journals Can Centralization of Cancer Surgery Improve Social Welfare?

2012 ◽  
Vol 15 (2) ◽  
pp. 1-25 ◽  
Author(s):  
Vivian Ho ◽  
Marah N. Short ◽  
Meei-Hsiang Ku-Goto
Keyword(s):  
Pancreatic Cancer ◽  
Colon Cancer ◽  
Social Welfare ◽  
Market Competition ◽  
High Volume ◽  
Market Concentration ◽  
Cancer Surgery ◽  
Negative Consequences ◽  
Mortality Cost ◽  
Procedure Volume

Abstract The empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the centralization of complex surgical procedures. Yet redirecting patients to a select number of high-volume hospitals creates potential negative consequences for market competition. We use patient-level data to estimate the association between hospital procedure volume and patient mortality and costs. We also estimate the association between hospital market concentration and mortality, cost, and prices. We use our estimates to simulate the change in social welfare resulting from redirecting patients at low-volume hospitals to high-volume facilities. We find that a higher procedure volume leads to significant reductions in mortality for patients undergoing surgery for pancreatic cancer, but not colon cancer. Procedure volume also influences costs for both surgeries, but in a nonlinear fashion. Increased market concentration is associated with higher costs and prices for colon cancer, but not pancreatic cancer patients. Simulations indicated that centralizing pancreatic cancer surgery is unambiguously welfare enhancing. In contrast, there is less evidence to suggest that centralizing colon cancer surgery would be welfare improving.

Low-volume centre vs high-volume: the role of a quality assurance programme in colon cancer surgery

2011 ◽  
Vol 13 (9) ◽  
pp. e276-e283 ◽  
Author(s):  
P. Mroczkowski ◽  
R. Kube ◽  
H. Ptok ◽  
U. Schmidt ◽  
S. Hac ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Quality Assurance ◽  
High Volume ◽  
Cancer Surgery ◽  
Quality Assurance Programme ◽  
Colon Cancer Surgery ◽  
Low Volume

Regionalization and Outcomes of Lung Cancer Surgery in Ontario, Canada

2017 ◽  
Vol 35 (24) ◽  
pp. 2772-2780 ◽  
Author(s):  
Anna M. Bendzsak ◽  
Nancy N. Baxter ◽  
Gail E. Darling ◽  
Peter C. Austin ◽  
David R. Urbach
Keyword(s):  
Lung Cancer ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Lung Cancer Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Economic Incentives ◽  
Cancer Surgery ◽  
Health Services Use ◽  
Cross Sectional

Purpose Regionalization of complex surgery to high-volume hospitals has been advocated based on cross-sectional volume-outcome studies. In April 2007, the agency overseeing cancer care in Ontario, Canada, implemented a policy to regionalize lung cancer surgery at 14 designated hospitals, enforced by economic incentives and penalties. We studied the effects of implementation of this policy. Methods Using administrative health data, we used interrupted time series models to analyze the immediate and delayed effects of implementation of the policy on the distribution of lung cancer surgery among hospitals, surgical outcomes, and health services use. Results From 2004 to 2012, 16,641 patients underwent surgery for lung cancer. The proportion of operations performed in designated hospitals increased from 71% to 89% after the policy was implemented. Although operative mortality decreased from 4.1% to 2.9% (adjusted odds ratio, 0.68; 95% CI, 0.58 to 0.81; P < .001), the reduction was due to a preexisting declining trend in mortality. In contrast, in the years after implementation of the policy, length of hospital stay decreased more than expected from the baseline trend by 7% per year (95% CI, 5% to 9%; P < .001), and the distance traveled by all patients to the hospital for surgery increased by 4% per year (95% CI, 0% to 8%; P = .03), neither of which were explained by preexisting trends. Analyses limited to patients ≥ 70 years of age demonstrated a reduction in operative mortality (odds ratio, 0.80 per year after regionalization; 95% CI, 0.67 to 0.95; P = .01). Conclusion A policy to regionalize lung cancer surgery in Ontario led to increased centralization of surgery services but was not independently associated with improvements in operative mortality. Improvements in length of stay and in operative mortality among elderly patients suggest areas where regionalization may be beneficial.

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