Faculty Collaboration Database

Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care. Surgery 2016 Oct;160(4):839-849

Date

08/16/2016

Pubmed ID

27524432

Pubmed Central ID

PMC5105905

DOI

10.1016/j.surg.2016.07.002

Scopus ID

2-s2.0-84981718409 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

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.

Author List

Kothari AN, Blanco BA, Brownlee SA, Evans AE, Chang VA, Abood GJ, Settimi R, Raicu DS, Kuo PC

Author

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Colectomy
Databases, Factual
Ecosystem
Esophagectomy
Female
Health Care Surveys
Hospital Mortality
Hospitals, High-Volume
Humans
Length of Stay
Male
Middle Aged
Pancreatectomy
Quality of Health Care
Role
Survival Analysis
United States