Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Ann Surg. 2007 May;245(5):777-83.

Hospital volume and late survival after cancer surgery.

Author information

  • 1Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA. jbirkmey@umich.edu

Abstract

CONTEXT:

Although hospital procedure volume is clearly related to operative mortality with many cancer procedures, its effect on late survival is not well characterized.

OBJECTIVE:

To examine relationships between hospital volume and late survival after different types of cancer resections.

DESIGN:

Using the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1992-2002), we identified all patients undergoing major resections for lung, esophageal, gastric, pancreatic, colon, and bladder cancer (n = 64,047). Relationships between hospital volume and survival were assessed using Cox proportional hazards models, adjusting for patient characteristics and use of adjuvant radiation and chemotherapy.

STUDY PARTICIPANTS:

U.S. Medicare patients residing in SEER regions.

MAIN OUTCOME MEASURES:

5-year survival.

RESULTS:

Although there were statistically significant relationships between hospital volume and 5-year survival with all 6 cancer types, the relative importance of volume varied markedly. Absolute differences in 5-year survival probabilities rates between low-volume hospitals (LVHs) and high-volume hospitals (HVHs) ranged from 17% for esophageal cancer resection (17% vs. 34%, respectively) to only 3% for colon cancer resection (45% vs. 48%). Absolute differences in 5-year survival between LVHs and HVHs fell between these ranges for lung (6%), gastric (6%), pancreatic (5%), and bladder cancer (4%). Volume-related differences in late survival could not be attributed to differences in rates of adjuvant therapy.

CONCLUSIONS:

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.

PMID:
17457171
[PubMed - indexed for MEDLINE]
PMCID:
PMC1877074
Free PMC Article

Images from this publication.See all images (1)Free text

PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins Icon for PubMed Central
    Loading ...
    Write to the Help Desk