Hospital Volume and Late Survival After Cancer Surgery

Birkmeyer, John D.; Sun, Yating; Wong, Sandra L.; Stukel, Thérèse A.

doi:10.1097/01.sla.0000252402.33814.dd

Cited by 582 publications

(447 citation statements)

References 22 publications

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“…Our observations and those of others also suggest that academic and comprehensive cancer centers are associated with higher case volumes. [22][23][24][25][26][27][28][29][30] Whether this particular association between nonwhite race and better surgical care exists in other malignancies deserves further investigation.…”

Section: Discussionmentioning

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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BACKGROUND:Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.METHODS:By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.RESULTS:Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).CONCLUSIONS:There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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“…Casemix correction Bilimoria 6 2008 National Cancer Data Base (NCDB) 86451 1634 A / G / C / S Billingsley 7 2007 SEER-Medicare 22672 662 2678 A / G / C / S / U Birkmeyer 8 2007 25 2004 ------------…”

Section: Patients Hospitals Surgeonsmentioning

confidence: 99%

Volume and outcome in colorectal cancer surgery

Gijn

Gooiker

Wouters

et al. 2010

European Journal of Surgical Oncology (EJSO)

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AimsThere is a growing consensus to concentrate high-risk surgical procedures to highvolume surgeons in high-volume hospitals. However, there is fierce debate about centralizing more common malignancies such as colorectal cancer. The objective of this review is to conduct a meta-analysis using the best evidence available on the volume-outcome relationship for colorectal cancer treatment. MethodsA systematic search was performed to identify all relevant articles studying the relation between hospital and/or surgeon volume and clinical outcomes for colorectal cancer. Using strict inclusion criteria, 23 articles were selected concerning colon cancer, rectal cancer or both diseases together as 'colorectal cancer'. Pooled estimated effect sizes were calculated using the casemix adjusted outcomes of the highest volume group opposed to the lowest volume group. Results High ConclusionsThe results show a clear and consistent relation between high volume providers and improved long term survival. This applies to both high volume hospitals and high volume surgeons. Most results show a relation between high volume providers and a reduced postoperative mortality, but evidence is less convincing.In the ideal world, extensive population based audit registrations with casemix adjusted feedback should make rigid minimal volume standards obsolete. Until then, using volume criteria for hospitals and surgeons treating colorectal cancer can improve mortality and especially long term survival.

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“…Since the 2000s, nine studies that each included at least 1000 patients have focused on long‐term survival after gastrectomy (Table 3), and four of these found a significant relationship between survival and hospital volume 23, 34, 35, 36. In a study from the USA showing a positive relationship between hospital volume and long‐term outcomes (HR, 0.82; 95% CI, 0.73–0.92; P <.001), differences in outcomes could not be explained by discrepancies in patient characteristics or operative mortality, suggesting that hospital volume was an independent predictor of long‐term survival after gastrectomy 35. In contrast, a Dutch study showed that high hospital volume was associated with long‐term survival after esophagectomy, but not after gastrectomy 37.…”

Section: Resultsmentioning

confidence: 99%

Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume?

Mukai

Kurokawa

Takiguchi

et al. 2017

Annals of Gastroent Surgery

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Surgical resection is the only curative treatment for gastric cancer. Postoperative outcomes may be affected by the average or total number of surgeries carried out at an institution (hospital volume) or by a surgeon (surgeon volume). Among seven large‐scale studies that each enrolled over 10 000 patients who underwent gastrectomy, six showed that higher hospital volume contributed to a lower mortality rate after gastrectomy. Surgeon volume was also reported by three of four studies that each included over 1000 patients to be a significant factor contributing to heterogeneity in mortality rates after gastrectomy. In contrast, most studies showed no relationship between hospital volume and postoperative morbidity. A significant long‐term relationship was demonstrated in four of nine studies that each included more than 1000 patients, but the other five studies showed negative results. A recent correlative study of randomized phase III trials for gastric cancer surgeries showed a significant relationship between hospital volume and postoperative morbidity in one trial but not in another trial. There was no correlation between overall survival and either hospital or surgeon volume. In addition, another correlative study of a phase III trial of randomized chemotherapy for unresectable or recurrent gastric cancer found that there was no correlation between hospital volume and overall survival, although there was a large degree of heterogeneity in median overall survival among participating institutions.

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Hospital Volume and Late Survival After Cancer Surgery

Abstract: Along with lower operative mortality, HVHs have better late survival rates with selected cancer resections than their lower-volume counterparts. Mechanisms underlying their better outcomes and thus opportunities for improvement remain to be identified.

Cited by 582 publications

References 22 publications

Variations in gastric cancer care

Variations in gastric cancer care

Volume and outcome in colorectal cancer surgery

Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume?

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