scholarly journals Association of Discretionary Hospital Volume Standards for High-risk Cancer Surgery With Patient Outcomes and Access, 2005-2016

JAMA Surgery ◽  
2019 ◽  
Vol 154 (11) ◽  
pp. 1005 ◽  
Author(s):  
Kyle H. Sheetz ◽  
Karan R. Chhabra ◽  
Margaret E. Smith ◽  
Justin B. Dimick ◽  
Hari Nathan
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Hospital Volume ◽  
Cancer Surgery ◽  
High Risk Cancer

Variation in Mortality After High-Risk Cancer Surgery

2012 ◽  
Vol 21 (3) ◽  
pp. 389-395 ◽  
Author(s):  
Amir A. Ghaferi ◽  
Justin B. Dimick
Keyword(s):  
High Risk ◽  
Cancer Surgery ◽  
High Risk Cancer

scholarly journals Influence of Trends in Hospital Volume Over Time on Patient Outcomes for High-Risk Surgery

2018 ◽  
Vol 227 (4) ◽  
pp. e31 ◽  
Author(s):  
Cécile Payet ◽  
Stéphanie Polazzi ◽  
Jean-Christophe Lifante ◽  
Eddy Cotte ◽  
Jean-François Obadia ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Hospital Volume ◽  
Over Time

scholarly journals Centralization of High-Risk Cancer Surgery Within Existing Hospital Systems

2019 ◽  
Vol 37 (34) ◽  
pp. 3234-3242 ◽  
Author(s):  
Kyle H. Sheetz ◽  
Justin B. Dimick ◽  
Hari Nathan
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Cancer Surgery ◽  
Independent Effect ◽  
Hospital System ◽  
American Hospital ◽  
Hospital Systems ◽  
High Risk Cancer

PURPOSE Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. We evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. PATIENTS AND METHODS We merged data from the American Hospital Association’s annual survey on hospital system affiliation with Medicare claims to identify patients undergoing surgery for pancreatic, esophageal, colon, lung, or rectal cancer between 2005 and 2014. We calculated the degree to which systems centralized each procedure by calculating the annual proportion of surgeries performed at the highest-volume hospital within each system. We then estimated the independent effect of centralization on the incidence of postoperative complications, death, and readmissions after accounting for patient, hospital, and system characteristics. RESULTS The average degree of centralization varied from 25.2% (range, 6.6% to 100%) for colectomy to 71.2% (range, 8.3% to 100%) for pancreatectomy. Greater centralization was associated with lower rates of postoperative complications and death for lung resection, esophagectomy, and pancreatectomy. For example, there was a 1.1% (95% CI, 0.8% to 1.4%) absolute reduction in 30-day mortality after pancreatectomy for each 20% increase in the degree of centralization within systems. Independent of volume and hospital quality, postoperative mortality for pancreatectomy was two times higher in the least centralized systems than in the most centralized systems (8.9% v 3.7%, P < .01). Centralization was not associated with better outcomes for colectomy or proctectomy. CONCLUSION Greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes. As hospitals affiliate in response to broader financial and organization pressures, these systems may also present unique opportunities to improve the quality of high-risk cancer care.

scholarly journals Influence of trends in hospital volume over time on patient outcomes for high-risk surgery

2019 ◽  
Author(s):  
Cécile Payet ◽  
Stéphanie Polazzi ◽  
Jean-Christophe Lifante ◽  
Eddy Cotte ◽  
Daniel Grinberg ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Hospital Volume ◽  
Learning Effect ◽  
Hazard Ratios ◽  
Outcome Relationship ◽  
Volume Outcome ◽  
Procedure Volume ◽  
The Individual ◽  
Over Time

Abstract Background The more frequent a hospital performs a procedure, the better the outcome of the procedure; however, the mechanisms of this volume-outcome relationship have not been deeply elucidated to date. We aimed to determine whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. Methods We included all patients who underwent one of ten digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Learning effect was investigated by considering the interaction between hospital groups and procedure year. Results Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients’ mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). Conclusions Trend in hospital volume over time does not appear to influence patient outcomes, which puts the relevance of the "practice-makes-perfect" dogma in question.

scholarly journals Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults

2020 ◽  
Vol 68 (3) ◽  
pp. 505-510 ◽  
Author(s):  
Anne M. Suskind ◽  
Shoujun Zhao ◽  
W. John Boscardin ◽  
Alexander Smith ◽  
Emily Finlayson
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Cancer Surgery ◽  
High Risk Cancer

scholarly journals Volume and process of care in high-risk cancer surgery

Cancer ◽  
2006 ◽  
Vol 106 (11) ◽  
pp. 2476-2481 ◽  
Author(s):  
John D. Birkmeyer ◽  
Yating Sun ◽  
Aaron Goldfaden ◽  
Nancy J.O. Birkmeyer ◽  
Therese A. Stukel
Keyword(s):  
High Risk ◽  
Cancer Surgery ◽  
Process Of Care ◽  
High Risk Cancer

Hospital characteristics associated with failure to rescue in high risk cancer surgery

2010 ◽  
Vol 211 (3) ◽  
pp. S97 ◽  
Author(s):  
Amir A. Ghaferi ◽  
John D. Birkmeyer ◽  
Nicholas H. Osborne ◽  
Justin B. Dimick
Keyword(s):  
High Risk ◽  
Cancer Surgery ◽  
Failure To Rescue ◽  
High Risk Cancer ◽  
Hospital Characteristics
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