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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2006

01-06-2006

Trends in Hospital and Surgeon Volume and Operative Mortality for Cancer Surgery

Published in: Annals of Surgical Oncology | Issue 6/2006

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Abstract

Background

We measured 13-year trends in operative mortality for six cancer resections. We then examined whether these trends are driven by changes in hospital and surgeon volume or by changes that occurred among all providers, regardless of volume.

Methods

We analyzed administrative discharge data on patients who received one of six cancer resections in Florida, New Jersey, and New York for three time periods: 1988 to 1991, 1992 to 1996, and 1997 to 2000. Descriptive statistics and nested regression models were used to test for changes in the association between inpatient mortality and annual hospital and annual surgeon volume over time, adjusting for patient and hospital characteristics.

Results

Unadjusted inpatient mortality rates for the six cancer resections declined between .8 and 4.0 percentage points between the time periods 1988 to 1991 and 1997 to 2000. Over this time period, annual hospital and surgeon volumes for the six cancer operations increased an average of 24.3% and 24.2%, respectively. The logistic regressions indicated a relatively stable relationship over time between both increased hospital and surgeon volume and lower inpatient mortality. Simulations suggest that increases in hospital and surgeon procedure volume over time led to a reduction in inpatient mortality ranging from .1 percentage points for rectal cancer to 2.3 percentage points for pneumonectomy.

Conclusions

Persistence of the volume-outcome relation and increasing hospital and surgeon volumes explain much of the decline over time in inpatient mortality for five of the six cancer operations studied. Concentrating cancer resections among high-volume providers should lead to further reduced inpatient mortality.
Literature
1.
Jemal A, Clegg LX, Ward E, et al. Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer 2004;101:3–27CrossRefPubMed
2.
Birkmeyer JD, Warshaw AL, Finlayson SRG, Grove MR, Tosteson ANA. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 1999;126:178–83PubMed
3.
Mitry E, Bouvier AM, Esteve J, Faivre J. Benefit of operative mortality reduction on colorectal cancer survival. Br J Surg 2002;89:1557–62CrossRefPubMed
4.
Sutton DN, Wayman J, Griffin SM. Learning curve for oesophageal cancer surgery. Br J Surg 1999;85:1399–402CrossRef
5.
Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 2002;237:509–14CrossRef
6.
Birkmeyer JD, Finlayson SRG, Tosteson ANA, Sharp SM, Warshaw AL, Fisher ES. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 1999;125:250–6PubMed
7.
Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280:1747–51CrossRefPubMed
8.
Harmon JW, Tang DG, Gordon TA, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 1999;230:404–13CrossRefPubMed
9.
Patti MG, Corvera CU, Glasgow RE, Way LW. A hospital’s annual rate of esophagectomy influences the operative mortality rate. J Gastrointest Surg 1998;2:186–92CrossRefPubMed
10.
Romano PS, Mark DH. Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. Chest 1992;101:1332–7PubMed
11.
Finlayson EVA, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract 2001;4:172–7PubMed
12.
Ho V. Evolution of the volume-outcome relation for hospitals performing coronary angioplasty. Circulation 2000;101:1806–11PubMed
13.
Birkmeyer JD, Siewers AE, Finlayson SR, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–37CrossRefPubMed
14.
Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003;238:161–7CrossRefPubMed
15.
Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. New York: Wiley Inter-Science, 2000
16.
McCulloch CE, Searle RS. Generalized, Linear and Mixed Models. New York: Wiley, 2001
17.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–27CrossRefPubMed
18.
Rabe-Hesketh S, Skrondal A, Pickles A. Reliable estimation of generalized linear mixed models using adaptive quadrature. Stata J 2002;2:1–21
19.
Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993;46:1075–9CrossRefPubMed
20.
Ho V. Evolution of the volume-outcome relationship for hospitals performing coronary angioplasty. Circulation 2000;101:1806–11PubMed
21.
Birkmeyer NJO, Goodney PP, Stukel TA, Hillner BE, Birkmeyer JD. Do cancer centers designated by the National Cancer Institute have better surgical outcomes? Cancer 2005;103:435–41CrossRefPubMed
22.
Goodney PP, Siewers AE, Stukel TA, Lucas FL, Wennberg DE, Birkmeyer JD. Is surgery getting safer? National trends in operative mortality. J Am Coll Surg 2002;195:219–27CrossRefPubMed
23.
Goodney PP, Lucas FL, Stukel TA, Birkmeyer JD. Surgeon specialty and operative mortality with lung resection. Ann Surg 2005;241:179–84PubMed
24.
Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 2000;284:3028–35CrossRefPubMed
25.
26.
Robinson JC. Hospital tiers in health insurance: balancing consumer choice with financial incentives. Health Aff 2003;W3:135–46
27.
American Health Planning Association. National Directory of Health Planning, Policy and Regulatory Agencies. 13th ed. Falls Church, VA: American Health Planning Association, 2002
Metadata
Title
Trends in Hospital and Surgeon Volume and Operative Mortality for Cancer Surgery
Publication date
01-06-2006
Published in
Annals of Surgical Oncology / Issue 6/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.07.021

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