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Comparison of Hospital Volume and Risk-Standardized Mortality Rate as a Proxy for Hospital Quality in Complex Oncologic Hepatopancreatobiliary Surgery.
Julian, William T; Elshami, Mohamedraed; Ammori, John B; Hardacre, Jeffrey M; Ocuin, Lee M.
Affiliation
  • Julian WT; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
  • Elshami M; Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
  • Ammori JB; Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
  • Hardacre JM; Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
  • Ocuin LM; Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. lee.ocuinmd@gmail.com.
Ann Surg Oncol ; 31(8): 4922-4930, 2024 Aug.
Article in En | MEDLINE | ID: mdl-38700800
ABSTRACT

BACKGROUND:

Centralization of hepatopancreatobiliary procedures to more experienced centers has been recommended but remains controversial. Hospital volume and risk-stratified mortality rates (RSMR) are metrics for interhospital comparison. We compared facility operative volume with facility RSMR as a proxy for hospital quality. PATIENTS AND

METHODS:

Patients who underwent surgery for liver (LC), biliary tract (BTC), and pancreatic (PDAC) cancer were identified in the National Cancer Database (2004-2018). Hierarchical logistic regression was used to create facility-specific models for RSMR. Volume (high versus low) was determined by quintile. Performance (high versus low) was determined by RSMR tercile. Primary outcomes included median facility RSMR and RSMR distributions. Volume- and RSMR-based redistribution was simulated and compared for reductions in 90-day mortality.

RESULTS:

A total of 106,217 patients treated at 1282 facilities were included; 17,695 had LC, 23,075 had BTC, and 65,447 had PDAC. High-volume centers (HVC) had lower RSMR compared with medium-volume centers and low-volume centers for LC, BTC, and PDAC (all p < 0.001). High-performance centers (HPC) had lower RSMR compared with medium-performance centers and low-performance centers for LC, BTC, and PDAC (all p < 0.001). Volume-based redistribution required 16.0 patients for LC, 11.2 for BTC, and 14.9 for PDAC reassigned to 15, 22, and 20 centers, respectively, per life saved within each US census region. RSMR-based redistribution required 4.7 patients for LC, 4.2 for BTC, and 4.9 for PDAC reassigned to 316, 403, and 418 centers, respectively, per life saved within each US census region.

CONCLUSIONS:

HVC and HPC have the lowest overall and risk-standardized 90-day mortality after oncologic hepatopancreatobiliary procedures, but RSMR may outperform volume as a measure of hospital quality.
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Full text: 1 Database: MEDLINE Main subject: Pancreatic Neoplasms / Biliary Tract Neoplasms / Hospitals, High-Volume / Hospitals, Low-Volume Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Ann Surg Oncol Journal subject: NEOPLASIAS Year: 2024 Type: Article Affiliation country: United States

Full text: 1 Database: MEDLINE Main subject: Pancreatic Neoplasms / Biliary Tract Neoplasms / Hospitals, High-Volume / Hospitals, Low-Volume Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Ann Surg Oncol Journal subject: NEOPLASIAS Year: 2024 Type: Article Affiliation country: United States