Disparities in the Utilization of High-Volume Hospitals for Complex Surgery

Liu, Jerome H.; Zingmond, David S.; McGory, Marcia L.; SooHoo, Nelson F.; Ettner, Susan L.; Brook, Robert H.; Ko, Clifford Y.

doi:10.1001/jama.296.16.1973

Cited by 445 publications

(339 citation statements)

References 32 publications

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“…Hispanic patients may be less likely to be seen at cancer centers or major medical centers with expertise in ESTS care. 24 Hispanics had the lowest rate of preoperative radiation therapy in univariate analysis, which partially may explain this result, because preoperative radiation therapy can be used to make limb preservation more practical in patients who otherwise would require amputation.…”

Section: Discussionmentioning

confidence: 96%

Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

Martinez

Robbins

Meyers³

et al. 2008

Cancer

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BACKGROUND.Limb preservation is preferred to amputation for patients with extremity soft tissue sarcoma (ESTS). Disparities in the treatment and outcomes of several malignancies have been reported, but not for ESTS. The authors assessed racial/ethnic differences in patient‐ and tumor‐specific characteristics, treatment, and disease‐specific survival in a population of adults with ESTS.METHODS.The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 6406 adult patients with ESTS who were diagnosed and treated between 1988 and 2003. Patients were categorized into 1 of 4 racial/ethnic groups: whites, blacks, Hispanics, and Asians. Comparisons of treatment and disease‐specific survival were conducted with regression models that adjusted for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology.RESULTS.Relative to whites, blacks received lower rates of adjuvant radiation with surgery (odds ratio [OR], 0.77; 95% confidence interval [95% CI], 0.66–0.90). Hispanics received significantly lower rates of limb‐sparing surgery (OR, 0.76; 95% CI, 0.59–0.97). In a multivariate analysis controlling for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology, blacks displayed a worse disease‐specific survival (hazard ratio [HR] 1.39; 95% CI, 1.13–1.70), whereas Asians demonstrated superior disease‐specific survival (HR, 0.67; 95% CI, 0.46–0.97).CONCLUSIONS.There were significant racial/ethnic differences in treatment and survival among adults with ESTS. Compared with whites, survival was poorer for blacks but better for Asians. These disparities were not explained by differences in patient or tumor characteristics. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 96%

Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

Martinez

Robbins

Meyers³

et al. 2008

Cancer

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“…The proportion of hospitals in the United States where cystectomy is performed varied up and down between 45% and 50% from 1988 to 1996 but between 1996 and 2000 it decreased to 39%. 6 Nonwhite patients and those with Medicaid or no insurance are already significantly less likely to receive health care in general 19 and undergo radical cystectomy in particular 20 at HVHs. Policies that potentiate trends toward regionalization run the risk of worsening existing disparities in health care access and quality across sociodemographic groups.…”

Section: Discussionmentioning

confidence: 99%

Trends in Regionalization of Inpatient Care for Urological Malignancies, 1988 to 2002

2007

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Purpose: Higher hospital and clinician volumes may be associated with improved patient outcomes for complex surgical and medical care, although the strength and consistency of this association varies markedly across specific conditions and procedures. Pressures from payors and policymakers exist to move complex care to high volume hospitals. The net effect of these pressures may be the regionalization of care. We quantified trends in the regionalization of inpatient care for urological oncology in a national administrative database. Materials and Methods: The Nationwide Inpatient Sample, a 20% stratified sample of United States community hospital admissions, was queried for surgical and nonsurgical admissions for bladder, renal and prostate cancer care between 1988 and 2002. Hospitals were grouped into tertiles by annual surgical volume. Trends over time in the annual discharge rate by hospital volume tertile, geographic region and insurance status were analyzed. Results: High volume hospitals were defined by at least 22, 12 and 26 cases per year for bladder, renal and prostate cancer, respectively. High volume hospital discharges increased significantly as a proportion of all discharges for bladder (67% to 70%) and renal (67% to 73%) cancer surgery, and they were essentially constant for prostate surgery (76%). Trends were similar for Medicare and Medicaid patients except high volume hospital discharges for prostate cancer decreased during the study period. Significant regional variation was observed for the regionalization of surgical and nonsurgical care. Conclusions: Nationwide Inpatient Sample data demonstrate the ongoing regionalization of urological oncology care. The policy implications of this trend are complex with potentially important benefits and risks in terms of access to and quality of care.

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“…This database has been used previously to examine health outcomes in both adult and pediatric populations. [28][29][30][31][32] …”

Section: Data Source and Linkagementioning

confidence: 99%

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

Jen

Rickard²,

Shew³

et al. 2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:There has been a dramatic increase in the use of adolescent bariatric surgery. However, previous studies were unable to distinguish laparoscopic versus open procedures. Furthermore, the use of laparoscopic adjustable gastric banding (LAGB) has not been studied on a population level. WHAT THIS STUDY ADDS:The rate of LAGB increased sevenfold from 2005 to 2007 with a corresponding decrease in the rate of laparoscopic Roux-en-Y gastric bypass. Furthermore, white adolescents represented only 28% of those who were overweight but accounted for 65% of the procedures.abstract OBJECTIVE: The goal of this study was to evaluate trends, and outcomes of adolescents who undergo bariatric surgery. PATIENTS AND METHODS: RESULTS:Overall, 590 adolescents (aged 13-20 years) underwent bariatric surgery in 86 hospitals. White adolescents represented 28% of those who were overweight but accounted for 65% of the procedures. Rates of laparoscopic adjustable gastric banding (LAGB) increased 6.9-fold from 0.3 to 1.5 per 100 000 population (P Ͻ .01), whereas laparoscopic Roux-en-Y gastric bypass (LRYGB) rates decreased from 3.8 to 2.7 per 100 000 population (P Ͻ .01). Self-payers were more likely to undergo LAGB (relative risk [RR]: 3.51 [95% confidence interval: 2.11-5.32]) and less likely to undergo LRYGB (RR: 0.45 [95% confidence interval: 0.33-0.58]) compared with privately insured adolescents. The rate of major in-hospital complication was 1%, and no deaths were reported. Of the patients who received LAGB, 4.7% had band revision/removal. In contrast, 2.9% of those who received LRYGB required reoperations. CONCLUSIONS:White adolescent girls disproportionately underwent bariatric surgery. Although LAGB has not been approved by the US Food and Drug Administration for use in children, its use has increased dramatically. There was a complication rate and no deaths. Long-term studies are needed to fully assess the efficacy, safety, and health care costs of these procedures in adolescents.

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Disparities in the Utilization of High-Volume Hospitals for Complex Surgery

Cited by 445 publications

References 32 publications

Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

Trends in Regionalization of Inpatient Care for Urological Malignancies, 1988 to 2002

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

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