scholarly journals Accessing surgical care for esophageal cancer: patient travel patterns to reach higher volume center

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Adrian Diaz ◽  
Sarah Burns ◽  
Desmond D’Souza ◽  
Peter Kneuertz ◽  
Robert Merritt ◽  
...  
Keyword(s):  
Health Planning ◽  
Surgical Care ◽  
High Volume ◽  
Travel Patterns ◽  
Care Access ◽  
Patient Travel ◽  
High Volume Hospital ◽  
High Volume Center ◽  
Low Volume ◽  
Esophagectomy For Cancer

SUMMARY While better outcomes at high-volume surgical centers have driven the regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate the travel patterns among patients undergoing esophagectomy to assess willingness of patients to travel for surgical care. The California Office of Statewide Health Planning database was used to identify patients who underwent esophagectomy between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed esophagectomy to get to a higher volume center, was assessed. Overall 3,269 individuals underwent an esophagectomy for cancer in 154 hospitals; only five hospitals were high volume according to Leapfrog standards. Median travel time to a hospital that performed esophagectomy was 26 minutes (IQR: 13.1–50.7). The overwhelming majority of patients (85%) bypassed the nearest providing hospital to seek care at a destination hospital. Among patients who bypassed a closer hospital, only 36% went to a high-volume hospital. Of the 2,248 patients who underwent esophagectomy at a low-volume center, 1,491 patients had bypassed a high-volume hospital. Of the remaining 757 patients who did not bypass a high-volume hospital, half of the individuals would have needed to travel less than an additional hour to reach a high-volume center. Nearly two-thirds of patients undergoing an esophagectomy for cancer received care at a low-volume center; 85% of patients either bypassed a high-volume hospital or would have needed to travel less than an additional hour to reach a high-volume center.

Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

2013 ◽  
Vol 23 (7) ◽  
pp. 1244-1251 ◽  
Author(s):  
Camille C. Gunderson ◽  
Ana I. Tergas ◽  
Aimee C. Fleury ◽  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Uterine Cancer ◽  
Multivariable Analysis ◽  
Community Setting ◽  
Surgical Care ◽  
High Volume ◽  
High Volume Hospital ◽  
To Receive ◽  
Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

340 Trends and Disparities in Cervical Spine Fusion Procedure Utilization in the New York State

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Rui Feng ◽  
Mark Finkelstein ◽  
Eric Karl Oermann ◽  
Michael Palese ◽  
John M Caridi
Keyword(s):  
New York ◽  
African American ◽  
Cervical Spine ◽  
New York State ◽  
High Volume ◽  
Spine Fusion ◽  
York State ◽  
High Volume Hospital ◽  
Low Volume ◽  
Cervical Spine Fusion

Abstract INTRODUCTION There has been a steady increase in spinal fusion procedures performed each year in the US, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. METHODS We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2005 to 2014 for the ICD-9-CM Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. We categorized all 122 hospitals high-, medium-, and low-volume. We then described the trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups using descriptive statistics. RESULTS >African American patients were significantly greater portion of patients receiving care at low-volume hospitals, 15.1% versus 11.6% at high-volume hospital. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7% respectively at high-volume centers. In addition, Compared with Caucasian patients, African American patients had higher rates of post-operative infection (P = 0.0020) and post-operative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of post-operative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). CONCLUSION Our results showed significant differences in racial distribution and primary payments methods between the low- and high-volume categories, and suggests that accessibility to care at high-volume centers remains problematic for these disadvantaged populations.

Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers

2022 ◽  
Author(s):  
Martin Lacher ◽  
Winfried Barthlen ◽  
Felicitas Eckoldt ◽  
Guido Fitze ◽  
Jörg Fuchs ◽  
...  
Keyword(s):  
Congenital Malformations ◽  
Surgical Care ◽  
High Volume ◽  
Anorectal Malformations ◽  
Posterior Urethral Valves ◽  
Insurance Companies ◽  
University Hospitals ◽  
Disease Category ◽  
Abdominal Emergencies ◽  
Low Volume

Abstract Introduction Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years. Methods Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into “high,” “medium,” and “low” volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period. Results From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18–258). Four institutions (21%) were classified as “high volume” centers, four (21%) as “medium volume” centers, and 11 (58%) as “low volume” centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%. Conclusion This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.

Defining pneumonia after esophagectomy for cancer: validation of the Uniform Pneumonia Score in a high volume center in North America

2018 ◽  
Vol 31 (6) ◽  
Author(s):  
M F J Seesing ◽  
A Wirsching ◽  
P S N van Rossum ◽  
T J Weijs ◽  
J P Ruurda ◽  
...  
Keyword(s):  
North America ◽  
High Volume ◽  
High Volume Center ◽  
Esophagectomy For Cancer

Creating an online resource providing hospital cancer surgery volumes in California.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 172-172
Author(s):  
Christina A Clarke ◽  
Laurence C Baker ◽  
Jennifer Malin ◽  
Joseph Parker ◽  
Merry Holliday-Hanson ◽  
...  
Keyword(s):  
Health Planning ◽  
Public Information ◽  
High Volume ◽  
Median Number ◽  
Cancer Surgery ◽  
Sufficient Evidence ◽  
Cancer Site ◽  
Volume Data ◽  
Volume Calculation ◽  
Low Volume

172 Background: Little evidence is available to help patients and providers, payers and policymakers find the highest-quality hospitals for cancer surgery. We initiated a groundbreaking effort in California ( www.calqualitycare.org ) to publicly report hospital cancer surgery volume data online. Methods: With financial support from the nonprofit California HealthCare Foundation, we assembled a multidisciplinary team to oversee the project and ensure sound methodology. We obtained existing hospital discharge summary data from the California Office of Statewide Health Planning and Development (OSHPD). We selected cancer surgeries eligible for display through comprehensive review of the literature addressing the association of hospital volume and mortality. We found eleven cancer sites with sufficient evidence of association including bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach. Experts advised volume calculation and display of results. Leaders of low volume hospitals were interviewed to understand the reasons for low volume. Results: In 2014, about 60% of cancer surgeries in California were performed at hospitals in the top 20% of volume, but many hospitals performed low numbers of complex procedures, with the per hospital median number of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries at 4 or less. Low-volume hospitals included rural and urban hospitals, with small and large bed sizes, and teaching and non-teaching status. At least 670 Californians received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer site; 72% of those patients lived within 50 miles of a top-20% volume hospital. Conclusions: This project demonstrates the potential for public information about hospital volumes to point patients towards high-volume and away from low-volume hospitals. Data regarding 2014 volumes are now available online.

Predictors of rectal cancer resection at high-volume hospitals among Medicare patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 808-808
Author(s):  
Mary E. Charlton ◽  
Catherine Chioreso ◽  
Irena Gribovskaja-Rupp ◽  
Chi Lin ◽  
Marcia M Ward ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Adenocarcinoma ◽  
High Volume ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Cancer Center ◽  
Medicare Beneficiaries ◽  
Co Morbidity ◽  
High Volume Hospital ◽  
Low Volume

808 Background: Hospitals that perform high volumes of rectal cancer resections achieve superior rates of sphincter preservation and survival compared to those that do not, but many rectal cancer resections are still performed in low-volume centers. We aimed to determine the patient, provider and pathway characteristics associated with receipt of surgery from high-volume hospitals. Methods: Patient and provider characteristics were extracted from the SEER-Medicare database for Medicare beneficiaries (age 66+) with stage II/III rectal adenocarcinoma diagnosed 2007-2011 who received rectal cancer-directed surgery. Hospitals were divided into quartiles by volume of rectal cancer resections, and were also classified by NCI cancer center designation. Results: 2056 patients were included, and 57% received surgery in a high-volume hospital or NCI-designated center. Those residing in census tracts classified as rural and having higher median incomes, lower poverty, and higher levels of education more frequently received surgery in high-volume hospitals; there were no differences by age, gender, stage, or co-morbidity status. 55% of patients received surgery at the same facility where they received the colonoscopy that identified their cancer. In multivariate analyses, the strongest predictor of receiving one’s surgery in a high-volume hospital was receipt of colonoscopy at a high-volume facility (OR = 3.75, 95% CI: 2.93-4.79). Those treated in high-volume hospitals more often had guideline-recommended staging (TRUS/MRI) and treatment (neoadjuvant chemoradiation). Conclusions: Rectal cancer patients tended to stay at the facility where their cancer was diagnosed; and did not typically seek out high-volume providers if their colonoscopy was performed in a low-volume facility. This suggests that colonoscopists may have substantial influence over where patients receive surgery. Given that rurality, income and education appear to more strongly predict receipt of surgery at a high-volume hospital compared to clinical characteristics, further research is needed to understand considerations driving patient decisions and referring providers’ recommendations for care.

Failure to Rescue As a Source of Variation in Hospital Mortality for Ovarian Cancer

2012 ◽  
Vol 30 (32) ◽  
pp. 3976-3982 ◽  
Author(s):  
Jason D. Wright ◽  
Thomas J. Herzog ◽  
Zainab Siddiq ◽  
Rebecca Arend ◽  
Alfred I. Neugut ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Complication Rate ◽  
Major Complication ◽  
High Volume ◽  
Complication Rates ◽  
Failure To Rescue ◽  
High Volume Hospital ◽  
Lower Complication ◽  
Major Complication Rate ◽  
Low Volume

Purpose Although the association between high surgical volume and improved outcomes from procedures is well described, the mechanisms that underlie this association are uncertain. There is growing recognition that high-volume hospitals may not necessarily have lower complication rates but rather may be better at rescuing patients with complications. We examined the role of complications, failure to rescue from complications, and mortality based on hospital volume for ovarian cancer. Patients and Methods The Nationwide Inpatient Sample was used to identify women who underwent surgery for ovarian cancer from 1988 to 2009. Hospitals were ranked on the basis of their procedure volume. We determined the risk-adjusted mortality, major complication rate, and “failure to rescue” rate (mortality in patients with a major complication) for each tertile. Univariate and multivariate associations were then compared. Results We identified 36,624 patients. The mortality rate for the cohort was 1.6%. The major complication rate was 20.4% at low-volume, 23.4% at intermediate-volume, and 24.6% at high-volume hospitals (P < .001). However, the rate of failure to rescue (death after a complication) was markedly higher at low-volume (8.0%) compared with high-volume hospitals (4.9%; P < .001). After accounting for patient and hospital characteristics, women treated at low-volume hospitals who experienced a complication were 48% more likely (odds ratio [OR], 1.48; 95% CI, 1.11 to 1.99) to die than patients with a complication at a high-volume hospital. Conclusion Mortality is lower for patients with ovarian cancer treated at high-volume hospitals. The reduction in mortality does not appear to be the result of lower complications rates but rather a result of the ability of high-volume hospitals to rescue patients with complications.

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