Should Operations Be Regionalized? The Empirical Relation between Surgical Volume and Mortality

Luft, Harold S.; Bunker, John P.; Enthoven, Alain C.

doi:10.1097/00132586-198012000-00060

Cited by 511 publications

(647 citation statements)

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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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“…Our finding of an association between annual case volume and outcome does bring into question any need for regionalization of care to high-volume hospitals. Many studies have found improved outcomes with regionalization of care for certain high-risk procedures [14,[27][28][29][30]. This has led to volume-based referral initiatives by organizations, such as the Leapfrog group, for selected high-risk procedures [31].…”

Section: Discussionmentioning

confidence: 99%

“…complex surgical operations. One of the first studies examining the relationship between hospital volume and surgical outcomes was published in 1979 by Luft et al [14]. Since that time, there have been numerous studies published on the association between hospital volume and surgical outcomes for complex, high-risk operations [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

et al. 2017

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“…There is evidence from some centers that short-term outcomes of pancreaticoduodenectomy are better at hospitals where a higher volume of these procedures is performed [95,96]. Sosa [90] et al showed that unadjusted mortality rates for all pancreatic cancer procedures increased as hospital volume decreased, even when the data were stratified by individual surgeon volume.…”

Section: The Hospital Volume Effectmentioning

confidence: 99%

Improving Survival of Pancreatic Cancer. What Have We Learnt?

Singh

Chaudhary

2015

Indian J Surg

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Pancreatic adenocarcinoma still ranks high among cancer-related deaths worldwide. In spite of substantial strides in preoperative staging, surgery, perioperative care, and adjuvant treatment, the survival still remains dismal. A number of patient-, disease-, and surgeon-related factors play a role in deciding the eventual outcome of the patient. The aim of this commentary is to review the current knowledge of various factors and the recent advances that impact the survival of patients with pancreatic adenocarcinoma. A search of scientific literature using Embase and MEDLINE, for the years 1985-2015, was carried out for search terms Bpancreatic cancer^and Bsurvival.^Further search was based on the various specific prognostic factors that contribute towards survival of patients with pancreatic cancer found in the literature. Most of the studies used for this review include those that deal with pancreatic head cancers, some include patients with pancreatic cancers in all locations while very few included patients with tumors of body and tail only. In spite of significant developments in pre-and perioperative management, increased rates of margin-negative resections, and use of adjuvant treatment, the survival rates of pancreatic cancer patients remains poor. A paradigm shift with more effective adjuvant regimen and genetic interventions may help change the outcomes of patients with pancreatic cancer.

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Should Operations Be Regionalized? The Empirical Relation between Surgical Volume and Mortality

Cited by 511 publications

References 0 publications

Variations in gastric cancer care

Variations in gastric cancer care

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Improving Survival of Pancreatic Cancer. What Have We Learnt?

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