 |
|
Hospital Volume and Operative Mortality in Cancer Surgery
A National Study
Emily V. A. Finlayson, MD;
Philip P. Goodney, MD;
John D. Birkmeyer, MD
Arch Surg. 2003;138:721-725.
Background Although initiatives to regionalize cancer surgery are already under way, the relative importance of volume in cancer surgery is disputed.
Hypothesis We examined surgical mortality with 8 cancer resections in the US population to better quantify the influence of hospital volume.
Methods Using information from the all-payer Nationwide Inpatient Sample (1995-1997), we examined mortality with 8 cancer resections (N = 195 152). After dividing patients into 3 evenly sized volume groups based on hospital procedure volume (low, medium, and high), we used regression techniques to describe relationships between hospital volume and in-hospital mortality, adjusting for patient characteristics.
Results Trends toward lower operative risks at high-volume hospitals were observed for 7 of the 8 procedures. However, differences between low- and highhigh-volume hospitals were statistically significant for only 3 operations (esophagectomy, 15.0% vs 6.5%; pancreatic resection, 13.1% vs 2.5%; and pulmonary lobectomy, 10.1% vs 8.9%, respectively). Although they did not reach statistical significance, absolute differences in mortality between low- and high-volume hospitals were greater than 1% for the following 3 procedures: gastrectomy, 8.7% vs 6.9%; cystectomy, 3.6% vs 2.5%; and pneumonectomy, 10.6% vs 8.9%, respectively. Mortality reductions for nephrectomy and colectomy were small. In general, in terms of absolute differences in mortality, the effect of volume was greatest in elderly patients.
Conclusions Operative mortality decreases with increasing hospital volume for several cancer resections. However, volume may be most important in patients who are older and at higher risk.
From the Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt (Drs Finlayson, Goodney, and Birkmeyer); Departments of Surgery (Drs Goodney and Birkmeyer) and Community and Family Medicine (Dr Birkmeyer), Dartmouth–Hitchcock Medical Center, Lebanon, NH; Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Dr Birkmeyer); and the Department of Surgery, University of California, San Francisco (Dr Finlayson).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLES
This Month in Archives of Surgery
Arch Surg. 2003;138(7):699.
FULL TEXT
Hospital Volume and Operative Mortality in Cancer Surgery—Invited Critique
Richard J. Davies
Arch Surg. 2003;138(7):726.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Legacy and Obligations of the Head and Neck Surgeon: The 2009 Hayes Martin Lecture
Cummings
Arch Otolaryngol Head Neck Surg 2009;135:1077-1081.
ABSTRACT
| FULL TEXT
The impact of center volume on survival in lung transplantation: an analysis of more than 10,000 cases.
Weiss et al.
Ann. Thorac. Surg. 2009;88:1062-1070.
ABSTRACT
| FULL TEXT
POINT: Operative risk of pneumonectomy--influence of preoperative induction therapy.
Gaissert et al.
J. Thorac. Cardiovasc. Surg. 2009;138:289-294.
ABSTRACT
| FULL TEXT
Patient and Hospital Characteristics on the Variance of Perioperative Outcomes for Pancreatic Resection in the United States: A Plea for Outcome-Based and Not Volume-Based Referral Guidelines
Teh et al.
Arch Surg 2009;144:713-721.
ABSTRACT
| FULL TEXT
Measuring the Quality of Surgical Outcomes in General Thoracic Surgery: Should Surgical Volume Be Used to Direct Patient Referrals?
Kozower et al.
Ann. Thorac. Surg. 2008;86:1405-1408.
FULL TEXT
Increased Mortality at Low-Volume Orthotopic Heart Transplantation Centers: Should Current Standards Change?
Weiss et al.
Ann. Thorac. Surg. 2008;86:1250-1260.
ABSTRACT
| FULL TEXT
Directing Surgical Quality Improvement Initiatives: Comparison of Perioperative Mortality and Long-Term Survival for Cancer Surgery
Bilimoria et al.
JCO 2008;26:4626-4633.
ABSTRACT
| FULL TEXT
Multidisciplinary Management of Patients with Advanced Rectal Cancer
Beart
Clin. Cancer Res. 2007;13:6890s-6893s.
ABSTRACT
| FULL TEXT
Quality of Care Issues in Colorectal Cancer
Leonardi et al.
Clin. Cancer Res. 2007;13:6897s-6902s.
ABSTRACT
| FULL TEXT
Case Volume as a Predictor of Inpatient Mortality After Esophagectomy
Rodgers et al.
Arch Surg 2007;142:829-839.
ABSTRACT
| FULL TEXT
Standards for Thoracic Surgical Oncology in a Single-Payer Healthcare System
Sundaresan et al.
Ann. Thorac. Surg. 2007;84:693-701.
ABSTRACT
| FULL TEXT
National Outcomes After Gastric Resection for Neoplasm
Smith et al.
Arch Surg 2007;142:387-393.
ABSTRACT
| FULL TEXT
Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery
Rouvelas et al.
Arch Surg 2007;142:113-117.
ABSTRACT
| FULL TEXT
Volume-Based Referral for Cancer Surgery: Informing the Debate
Hollenbeck et al.
JCO 2007;25:91-96.
ABSTRACT
| FULL TEXT
Surgical Mortality in Patients With Esophageal Cancer: Development and Validation of a Simple Risk Score
Steyerberg et al.
JCO 2006;24:4277-4284.
ABSTRACT
| FULL TEXT
Laparoscopic-Assisted Pancreatic Necrosectomy: A New Surgical Option for Treatment of Severe Necrotizing Pancreatitis
Parekh
Arch Surg 2006;141:895-903.
ABSTRACT
| FULL TEXT
Hospital volume: operative morbidity, mortality and survival in thoracotomy for lung cancer.: A Spanish multicenter study of 2994 cases
Freixinet et al.
Eur. J. Cardiothorac. Surg. 2006;29:20-25.
ABSTRACT
| FULL TEXT
What is the best management strategy for high grade dysplasia in Barrett's oesophagus? A cost effectiveness analysis
Shaheen et al.
Gut 2004;53:1736-1744.
ABSTRACT
| FULL TEXT
|
