Hospital volume and late survival after cancer surgery

Ann Surg. 2007 May;245(5):777-83. doi: 10.1097/01.sla.0000252402.33814.dd.

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Gastrointestinal Neoplasms / mortality*
  • Gastrointestinal Neoplasms / surgery
  • Health Facility Size
  • Humans
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / surgery
  • Male
  • Pancreatic Neoplasms / mortality*
  • Pancreatic Neoplasms / surgery
  • Retrospective Studies
  • SEER Program
  • Surgical Procedures, Operative / statistics & numerical data*
  • Survival Rate
  • United States / epidemiology
  • Urinary Bladder Neoplasms / mortality*
  • Urinary Bladder Neoplasms / surgery