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. 2016 Oct;160(4):839-849.
doi: 10.1016/j.surg.2016.07.002. Epub 2016 Aug 11.

Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care

Anai N Kothari  1 , Barbara A Blanco  1 , Sarah A Brownlee  2 , Ann E Evans  1 , Victor A Chang  2 , Gerard J Abood  1 , Raffaella Settimi  3 , Daniela S Raicu  3 , Paul C Kuo  4
Affiliations

Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care

Anai N Kothari et al. Surgery. 2016 Oct.

Abstract

Background: Our objective was to determine the hospital resources required for low-volume, high-quality care at high-volume cancer resection centers.

Methods: Patients who underwent esophageal, pancreatic, and rectal resection for malignancy were identified using Healthcare Cost and Utilization Project State Inpatient Database (Florida and California) between 2007 and 2011. Annual case volume by procedure was used to identify high- and low-volume centers. Hospital data were obtained from the American Hospital Association Annual Survey Database. Procedure risk-adjusted mortality was calculated for each hospital using multilevel, mixed-effects models.

Results: A total of 24,784 patients from 302 hospitals met the inclusion criteria. Of these, 13 hospitals were classified as having a high-volume, oncologic resection ecosystem by being a high-volume hospital for ≥2 studied procedures. A total of 11 of 31 studied hospital factors were strongly associated with hospitals that performed a high volume of cancer resections and were used to develop the High Volume Ecosystem for Oncologic Resections (HIVE-OR) score. At low-volume centers, increasing HIVE-OR score resulted in decreased mortality for rectal cancer resection (P = .038). HIVE-OR was not related to risk-adjusted mortality for esophagectomy (P = .421) or pancreatectomy (P = .413) at low-volume centers.

Conclusion: Our study found that in some settings, low-volume, high-quality cancer surgical care can be explained by having a high-volume ecosystem.

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Figures

Figure 1
Figure 1
Overview of study design.
Figure 2
Figure 2
Hospital risk-adjusted mortality for each procedure, by volume. A) Esophagus cancer resection (N=1,540). B) Pancreatic cancer resection (N=4,999). C) Rectal cancer resection (N=18,245). Vertical line in each panel demarcates the high volume threshold.
Figure 3
Figure 3
Development of the High Volume Ecosystem for Oncologic Resection (HIVE-OR) score. A) Components used to calculate the HIVE-OR score. Hospitals given 1 point for the presence of each characteristic to create a maximum score of 11. B) Box-plot HIVE-OR score distribution between high and low volume centers. C) Sensitivity and specificity for correctly classifying a hospital as having a high volume healthcare ecosystem at each HIVE-OR score. D) Receiver operating curve using the additive HIVE-OR score for classifying hospitals as having a high volume healthcare ecosystem. E) Number of high and low volume hospitals at each value of the HIVE-OR score. 1Highest quartile (>19,500 total annual admissions); 2Highest quartile (>5,000 total annual cases; 3Highest quartile (>0.07 total residents per hospital bed); 4Highest quartile (>1.7 total nurses per hospital bed).
Figure 4
Figure 4
Measuring the relationship between the HIVE-OR score and risk-adjusted mortality at low volume centers. A) HIVE-OR score and risk-adjusted mortality for esophagus cancer resection (N=40). B) HIVE-OR score and risk-adjusted mortality for pancreatic cancer resection (N=84). C) HIVE-OR score and risk-adjusted mortality for rectal cancer resection (N=231). Dotted line in each panel fitted linear regression.
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Comment in

  • Discussion.
    [No authors listed] [No authors listed] Surgery. 2016 Oct;160(4):848-849. doi: 10.1016/j.surg.2016.07.006. Epub 2016 Aug 11. Surgery. 2016. PMID: 27524433 No abstract available.

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