Key Points
Question
What information may motivate the US public to travel to safer hospitals for complex cancer surgery, what barriers to traveling do they face, and what solutions may facilitate appropriately changing hospitals?
Findings
In this nationally representative survey study, 92% of respondents would be motivated to travel to a specialty cancer hospital for superior safety or oncologic outcomes, but 74% also reported barriers to traveling, although most of the barriers could be overcome with proposed solutions. Specific socioeconomic subsets were less likely to travel.
Meaning
It appears that most of the US public could be motivated to travel to safer hospitals for complex cancer surgery, yet most would require some support to move. Further efforts to ensure that benefits from regionalization are equitable across sociodemographic strata are indicated.
Importance
Leading cancer hospitals have increasingly shared their brands with other hospitals through growing networks of affiliations. However, the brand of top-ranked cancer hospitals may evoke distinct reputations for safety and quality that do not extend to all hospitals within these networks.
Objective
To assess perioperative mortality of Medicare beneficiaries after complex cancer surgery across hospitals participating in networks with top-ranked cancer hospitals.
Design, Setting, and Participants
A cross-sectional study was performed of the Centers for Medicare & Medicaid Services 100% Medicare Provider and Analysis Review file from January 1, 2013, to December 31, 2016, for top-ranked cancer hospitals (as assessed by
U.S. News and World Report
) and affiliated hospitals that share their brand. Participants were 29 228 Medicare beneficiaries older than 65 years who underwent complex cancer surgery (lobectomy, esophagectomy, gastrectomy, colectomy, and pancreaticoduodenectomy [Whipple procedure]) between January 1, 2013, and October 1, 2016.
Exposures
Undergoing complex cancer surgery at a top-ranked cancer hospital vs an affiliated hospital.
Main Outcomes and Measures
Risk-adjusted 90-day mortality estimated using hierarchical logistic regression and comparison of the relative safety of hospitals within each cancer network estimated using standardized mortality ratios.
Results
A total of 17 300 patients (59.2%; 8612 women and 8688 men; mean [SD] age, 74.7 [6.2] years) underwent complex cancer surgery at 59 top-ranked hospitals and 11 928 patients (40.8%; 6287 women and 5641 men; mean [SD] age, 76.2 [6.9] years) underwent complex cancer surgery at 343 affiliated hospitals. Overall, surgery performed at affiliated hospitals was associated with higher 90-day mortality (odds ratio, 1.40; 95% CI, 1.23-1.59;
P
< .001), with odds ratios that ranged from 1.32 (95% CI, 1.12-1.56;
P
= .001) for colectomy to 2.04 (95% CI, 1.41-2.95;
P
< .001) for gastrectomy. When the relative safety of each top-ranked cancer hospital was compared with its collective affiliates, the top-ranked hospital was safer than the affiliates in 41 of 49 studied networks (83.7%; 95% CI, 73.1%-93.3%).
Conclusions and Relevance
The likelihood of surviving complex cancer surgery appears to be greater at top-ranked cancer hospitals compared with the affiliated hospitals that share their brand. Further investigation of performance across trusted cancer networks could enhance informed decision making for complex cancer care.
The World Health Organization (WHO) Safe Surgery Saves Lives campaign aimed to implement safe surgical procedures and patient safety best practices to reduce the incidence of adverse events both in the operating room and in the ward. For decades, the main objectives of safe surgery were mainly focused on the technical procedure. More recently, the implementation of non-technical skills and interpersonal communication have been found to play a significant role in preventing harm in surgical care settings.
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