Who receives their complex cancer surgery at low-volume hospitals?

Waddah B. Al-Refaie, Binyam Muluneh, Wei Zhong, Helen M. Parsons, Todd M. Tuttle, Selwyn M. Vickers, Elizabeth B Habermann

Research output: Contribution to journalArticle

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Abstract

Previous literature has consistently shown worse operative outcomes at low-volume hospitals (LVH) after complex cancer surgery. Whether patient-related factors impact this association remains unknown. We hypothesize that patient-related factors contribute to receipt of complex cancer surgery at LVH. Using the 20032008 National Inpatient Sample, we identified 59,841 patients who underwent cancer operations for lung, esophagus, and pancreas tumors. Logistic regression models were used to examine the impact of sociodemographic factors on receipt of complex cancer surgery at LVH. Overall, 38.4% received their cancer surgery at LVH. A higher proportion of esophagectomies were performed at LVH (70.3%), followed by pancreatectomy (38.2%) and lung resection (33.8%). Patients who were non-white, with non-private insurance, and had more comorbidities were all more likely to receive their cancer surgery at LVH (for all, p < 0.05). Multivariate analyses continued to demonstrate that nonwhite race, insurance status, increased comorbidities, region, and nonelective admission predicted receipt of cancer surgery at LVH across all 3 procedures. In this large national study, non-white race and increased comorbidities contributed to receipt of cancer surgery at LVH. Patient selection and access to high-volume hospitals are likely reasons worthy of additional investigation. This study provides additional insight into the volumeoutcomes relationship. Given the demonstrated outcomes disparity between high-volume hospitals and LVH, future policy and research should encourage mechanisms for referral of patients with cancer to high-volume hospitals for their surgical care.

Original languageEnglish (US)
Pages (from-to)81-87
Number of pages7
JournalJournal of the American College of Surgeons
Volume214
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

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Low-Volume Hospitals
High-Volume Hospitals
Neoplasms
Comorbidity
Logistic Models
Pancreatectomy
Insurance Coverage
Esophagectomy
Insurance
Patient Selection
Esophagus
Inpatients
Pancreas
Lung Neoplasms
Referral and Consultation
Multivariate Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Who receives their complex cancer surgery at low-volume hospitals? / Al-Refaie, Waddah B.; Muluneh, Binyam; Zhong, Wei; Parsons, Helen M.; Tuttle, Todd M.; Vickers, Selwyn M.; Habermann, Elizabeth B.

In: Journal of the American College of Surgeons, Vol. 214, No. 1, 01.2012, p. 81-87.

Research output: Contribution to journalArticle

Al-Refaie, Waddah B. ; Muluneh, Binyam ; Zhong, Wei ; Parsons, Helen M. ; Tuttle, Todd M. ; Vickers, Selwyn M. ; Habermann, Elizabeth B. / Who receives their complex cancer surgery at low-volume hospitals?. In: Journal of the American College of Surgeons. 2012 ; Vol. 214, No. 1. pp. 81-87.
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