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01-08-2005

High Hospital Volume Is Associated with Better Outcomes for Breast Cancer Surgery: Analysis of 233,247 Patients

Authors: Ulrich Guller, M.D., MHS, Shawn Safford, M.D., Ricardo Pietrobon, M.D., Ph.D, Michael Heberer, M.D., MBA, Daniel Oertli, M.D., FACS, Nitin B. Jain, M.D., MSPH

Published in: World Journal of Surgery | Issue 8/2005

Abstract

Background:

The relationship between hospital volume and outcomes needs to be further elucidated for low-risk procedures such as surgical therapy of localized breast cancer. The objective of this investigation was to assess the relationship between hospital volume and outcomes for breast cancer surgery.

Methods:

A total of 233,247 patients who underwent breast-conserving therapy (BCT) and breast-ablative therapy (BAT) for localized breast cancer were extracted from 13 years (1988–2000) of the Nationwide Inpatient Samples. Hospital volume was classified as low (<30 cases/year), intermediate (≥ 30 to <70cases/year), and high (≥ 70 cases/year). Multiple linear and logistic regression analyses were used to assess the risk-adjusted association between hospital volume and outcomes.

Results:

In risk-adjusted analyses, patients operated on at low-volume hospitals were 3.04 (p = 0.03) times more likely to die after BCT compared with patients operated on at high-volume hospitals. Similarly, low-volume hospitals had a significantly higher likelihood of postoperative complications (odds ratio [OR] = 1.73, p = 0.01 for BCT; OR = 1.44, p < 0.001 for BAT) compared with high-volume hospitals. Compared with low-volume hospitals, length of hospital stay was significantly shorter and nonroutine patient discharge significantly lower for high-volume providers for both BCT and BAT (all p < 0.001). Patients were also significantly less likely to undergo BCT if operated on in a low- or intermediate-volume hospital compared with a high-volume provider (p < 0.001).

Conclusions:

High-volume hospitals had significantly lower nonroutine patient discharge, postoperative morbidity and mortality, shorter length of hospital stay, and higher likelihood of performing BCT. Referral of patients with localized breast cancer to high-volume hospitals may be justified.

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Title: High Hospital Volume Is Associated with Better Outcomes for Breast Cancer Surgery: Analysis of 233,247 Patients
Authors: Ulrich Guller, M.D., MHS
Shawn Safford, M.D.
Ricardo Pietrobon, M.D., Ph.D
Michael Heberer, M.D., MBA
Daniel Oertli, M.D., FACS
Nitin B. Jain, M.D., MSPH
Publication date: 01-08-2005
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 8/2005
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-005-7831-z

At a glance: The STEP trials

Springer Medicine

High Hospital Volume Is Associated with Better Outcomes for Breast Cancer Surgery: Analysis of 233,247 Patients

Abstract

Background:

Methods:

Results:

Conclusions:

At a glance: The STEP trials

Springer Medicine

Abstract

Background:

Methods:

Results:

Conclusions:

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