The Academic Facility Is Associated with Higher Utilization of Esophagectomy and Improved Overall Survival for Esophageal Carcinoma

Merritt, Robert E.; Abdel‐Rasoul, Mahmoud; Fitzgerald, Morgan; D’Souza, Desmond M.; Kneuertz, Peter J.

doi:10.1007/s11605-020-04817-x

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…For some pathologies, outcomes are reportedly better at academic versus community hospitals regardless of caseload, which may be related to more homogeneity in biological behavior of the pathology at hand. [33][34][35] However, the present study demonstrated that neither facility type nor volume predicts OS in HNMM. Relative case volume may not be significant because HNMM is such a rare disease with a very poor prognosis.…”

Section: Discussioncontrasting

confidence: 80%

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The Impact of Facility Type and Volume on Outcomes in Head and Neck Mucosal Melanoma

Roman

Torabi

Bitner

et al. 2023

Otolaryngol.--head neck surg.

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Objective. To evaluate differences in treatment outcomes for head and neck mucosal melanoma (HNMM) patients seen at academic versus nonacademic centers and high versus low volume facilities.Study Design. Retrospective cohort study.Setting. National Cancer Database.Methods. Differences in treatment course and overall survival (OS) by facility type and volume were assessed for 2772 HNMM cases reported by the 2004 to 2017 National Cancer Database. A subgroup analysis was performed with a smaller cohort containing staging data. The analysis employed Kaplan-Meier and Cox proportional hazards models.Results. A higher proportion of patients treated at academic centers within the HNMM cohort waited longer for surgery after diagnosis (p < .001), had negative surgical margins (p < .001), and were readmitted to the hospital within 30 days of surgery (p = .001); these relationships remained significant when controlling for cancer stage. Kaplan-Meier analysis demonstrated higher 5-year OS for patients treated at academic versus nonacademic facilities within the main cohort (32.5% ± 1.3% vs 27.3% ± 1.5%; p = .006) and within the stagecontrolled subgroup (34.8% ± 2.1% vs 27.2% ± 2.6%; p = .003). Treatment at high volume versus low volume facilities was associated with improved 5-year OS for main cohort patients (33.5% ± 1.7% vs 28.8% ± 1.2%; p = .016) but not for subgroup patients (35.3% ± 2.7% vs 30.1% ± 2.1%; p = .100). Upon multivariate analysis controlling for demographic and oncologic factors, there was no significant difference in OS by facility type (main cohort: odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.01-1.21; subgroup: OR = 1.13, 95% CI = 0.97-1.32). Conclusion.Neither facility type nor surgical volume predicts overall survival in HNMM.

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Section: Discussioncontrasting

confidence: 80%

“…However, hospital volume and academic status are not always congruent. For some pathologies, outcomes are reportedly better at academic versus community hospitals regardless of caseload, which may be related to more homogeneity in biological behavior of the pathology at hand 33‐35 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Facility Type and Volume on Outcomes in Head and Neck Mucosal Melanoma

Roman

Torabi

Bitner

et al. 2023

Otolaryngol.--head neck surg.

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“…It is possible that these facilities offer greater access to experienced esophageal surgeons and advanced postoperative care, and this drives an increase in the number of esophagectomies performed. 16 Facility case volume was not an independent predictor of overall survival in our study. Although high overall case volume successfully correlated with a higher likelihood of surgery in both academic and community facilities, it was only associated with improved survival in academic facilities.…”

Section: Discussioncontrasting

confidence: 75%

Impact of facility type and volume in locally advanced esophageal cancer

Muslim,

Stroever,

Poulikidis

et al. 2023

Asian Cardiovasc Thorac Ann

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Background We hypothesized that academic facilities and high-volume facilities would be independently associated with improved survival and a greater propensity for performing surgery in locally advanced esophageal cancer. Methods We identified patients diagnosed with stage IB–III esophageal cancer during 2004–2016 from the National Cancer Database. Facility type was categorized as academic or community, and facility volume was based on the number of times a facility's unique identification code appeared in the dataset. Each facility type was dichotomized into high- and low-volume subgroups using the cutoff of 20 esophageal cancers treated/year. We fitted multivariable regression models in order to assess differences in surgery selection and survival between facilities according to type and volume. Results Compared to patients treated at high-volume community hospitals, those at high-volume academic facilities were more likely to undergo surgery (odds ratio: 1.865, p < 0.001) and were associated with lower odds of death (odds ratio: 0.784, p = 0.004). For both academic and community hospitals, patients at high-volume facilities were more likely to undergo surgery compared to those at low-volume facilities, p < 0.05. For patients treated at academic facilities, high-volume facilities were associated with lower odds of death (odds ratio: 0.858, p = 0.02) compared to low-volume facilities, while there was no significant difference in the odds of death between high- and low-volume community hospitals (odds ratio: 1.018, p = 0.87). Conclusions Both facility type and case volume impact surgery selection and survival in locally advanced esophageal cancer. Compared to community hospitals, academic facilities were more likely to perform surgery and were associated with improved survival.

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“…This may be surprising, as academic centers generally show superior outcomes following esophagectomy for esophageal cancer 19 . Considerations at academic institutions that may affect LOS include increased diagnostic tests and work‐up 20 and increased disease complexity, such as advanced clinical stage 19 . Our analysis also showed that white race (versus non‐white race) was associated with a shorter LOS.…”

Section: Discussionmentioning

confidence: 73%

“…Academic institution as the hospital facility had the greatest association with increased LOS after esophagectomy for esophageal cancer. This may be surprising, as academic centers generally show superior outcomes following esophagectomy for esophageal cancer 19 . Considerations at academic institutions that may affect LOS include increased diagnostic tests and work‐up 20 and increased disease complexity, such as advanced clinical stage 19 .…”

Section: Discussionmentioning

confidence: 99%

Concurrent diagnosis of anxiety increases postoperative length of stay among patients receiving esophagectomy for esophageal cancer

et al. 2021

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Objective Psychiatric comorbidities disproportionately affect patients with cancer. While identified risk factors for prolonged length of stay (LOS) after esophagectomy are primarily medical comorbidities, the impact of psychiatric comorbidities on perioperative outcomes is unclear. We hypothesized that psychiatric comorbidities would prolong LOS in patients with esophageal cancer. Methods The 2016 National Inpatient Sample (NIS) was used to identify patients with esophageal cancer receiving esophagectomy. Concurrent psychiatric illness was categorized using Clinical Classifications Software Refined for ICD‐10, creating 34 psychiatric diagnosis groups (PDGs). Only PDGs with >1% prevalence in the cohort were included in the analysis. The outcome of interest was hospital LOS. Bivariable testing was performed to determine the association of PDGs and demographic factors on LOS using rank sum test. Multivariable regression analysis was performed using backward selection from bivariable testing (α ≤ 0.05). Results We identified 1,730 patients who underwent esophagectomy for esophageal cancer in the 2016 NIS. The median LOS was 8 days (IQR 5‐12). In bivariable testing, a concurrent diagnosis of anxiety was the only PDG associated with LOS (9 days (IQR 6‐14) with anxiety diagnosis versus 8 days (IQR 5–12) with no anxiety diagnosis, p = 0.022). Multivariable modeling showed an independent association between anxiety diagnosis and increased LOS (OR 4.82 (1.25–25.23), p = 0.022). Anxiety was not associated with increased hospital cost or in‐hospital mortality. Conclusions This analysis demonstrates an independent effect of anxiety prolonging postoperative LOS after esophagectomy in the United States. These findings may influence perioperative care, patient expectations, and resource allocation.

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The Academic Facility Is Associated with Higher Utilization of Esophagectomy and Improved Overall Survival for Esophageal Carcinoma

Cited by 6 publications

References 23 publications

The Impact of Facility Type and Volume on Outcomes in Head and Neck Mucosal Melanoma

The Impact of Facility Type and Volume on Outcomes in Head and Neck Mucosal Melanoma

Impact of facility type and volume in locally advanced esophageal cancer

Concurrent diagnosis of anxiety increases postoperative length of stay among patients receiving esophagectomy for esophageal cancer

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