ASO Author Reflections: Variation in Hospital Mortality After Complex Cancer Surgery: Patient, Volume, Hospital, or Social Determinants?

Excerpt

Access to high-quality surgical services for cancer patients is increasingly hindered by a diverse array of obstacles. Key factors, such as patient attributes (i.e., age, sex, and race), hospital traits (i.e., teaching status and the ratio of nurses to patients), surgical case volume, and social determinants (i.e., insurance status, travel time to the hospital, and social vulnerability index), have been identified as impediments to the provision of high-quality surgical care.^1,2 Recent healthcare technology and infrastructure improvements have concentrated high-risk cancer surgery in specialized centers, which, while potentially improving postoperative outcomes for some, raises concerns that excessive centralization may exacerbate inequities and reduce access for marginalized groups.³ The association between surgical volume and perioperative outcomes does not exist in a vacuum, and the effects of various other factors at the patient, hospital, and neighborhood levels on this relationship remain ill-studied. As such, the current work sought to define the contributions of patient characteristics (PC), hospital characteristics (HC), case volume (CV), and social determinants (SDoH) on variations of in-hospital mortality (IHM) among patients receiving complex cancer care within the state of California.⁴ …