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 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 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

Utilization and effectiveness of extended-duration thromboprophylaxis after high-risk abdominopelvic cancer surgery.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 62-62
Author(s):  
Jason Dennis Wright ◽  
Ling Chen ◽  
Soledad Jorge ◽  
William M. Burke ◽  
Ana Tergas ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Molecular Weight ◽  
Endometrial Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Low Molecular Weight Heparin ◽  
Cancer Surgery ◽  
Low Molecular Weight ◽  
Extended Duration ◽  
High Risk Cancer

62 Background: Extended-duration thromboprophylaxis for 4 weeks after discharge has been demonstrated to reduce venous thromboembolic events (VTE) in cancer patients undergoing abdominopelvic surgery and is recommended in national guidelines. We examined the utilization and effectiveness of extended-duration low molecular weight heparin prophylaxis in high-risk cancer patients after surgery. Methods: We analyzed patients with colon, ovarian, and uterine cancer who underwent surgery from 2009-2013 and who were recorded in the MarketScan database. Multivariable models and propensity score analysis with inverse probability of treatment weights were developed to examine uptake and predictors of use of post-discharge low molecular weight heparin (LMWH) use, VTE incidence, and associated adverse events (transfusion, and hemorrhage). Results: A total of 63,280 patients were identified. Use of extended-duration prophylaxis increased from 2009 to 2013 from 1.4% to 1.7% (P = 0.67) for colectomy, 5.9% to 18.3% for ovarian cancer surgery (P < 0.001), and 6.3% to 12.2% (P < 0.001) for hysterectomy for endometrial cancer. There was no association between use of extended-duration prophylaxis and reductions in VTE for any of the procedures: colectomy (2.4% with extended-duration prophylaxis vs. 2.9% without prophylaxis, OR = 0.84; 95% CI, 0.54-1.31), ovarian cancer-directed surgery (3.7% vs. 3.6%, OR = 1.01; 95% CI, 0.76-1.33), hysterectomy (2.1% vs. 2.1%; OR = 0.96; 95% CI, 0.67-1.38). Extended-duration prophylaxis was associated with an increased risk of adverse postoperative events: 2.20 (95% CI, 1.51-3.19) after colectomy, 1.24 (95% CI, 0.92-1.68) following ovarian cancer-directed surgery and 0.99 (95% CI, 0.66-1.48) for hysterectomy for endometrial cancer. Conclusions: Use of extended-duration thromboprophylaxis is low among high-risk cancer patients undergoing surgery. The effectiveness of prophylaxis in real world populations requires further evaluation.

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
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