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Hospital Volume and Operative Mortality in Cancer Surgery
A National Study
Emily V. A. Finlayson, MD;
Philip P. Goodney, MD;
John D. Birkmeyer, MD
Arch Surg. 2003;138:721-725.
Background Although initiatives to regionalize cancer surgery are already under way, the relative importance of volume in cancer surgery is disputed.
Hypothesis We examined surgical mortality with 8 cancer resections in the US population to better quantify the influence of hospital volume.
Methods Using information from the all-payer Nationwide Inpatient Sample (1995-1997), we examined mortality with 8 cancer resections (N = 195 152). After dividing patients into 3 evenly sized volume groups based on hospital procedure volume (low, medium, and high), we used regression techniques to describe relationships between hospital volume and in-hospital mortality, adjusting for patient characteristics.
Results Trends toward lower operative risks at high-volume hospitals were observed for 7 of the 8 procedures. However, differences between low- and highhigh-volume hospitals were statistically significant for only 3 operations (esophagectomy, 15.0% vs 6.5%; pancreatic resection, 13.1% vs 2.5%; and pulmonary lobectomy, 10.1% vs 8.9%, respectively). Although they did not reach statistical significance, absolute differences in mortality between low- and high-volume hospitals were greater than 1% for the following 3 procedures: gastrectomy, 8.7% vs 6.9%; cystectomy, 3.6% vs 2.5%; and pneumonectomy, 10.6% vs 8.9%, respectively. Mortality reductions for nephrectomy and colectomy were small. In general, in terms of absolute differences in mortality, the effect of volume was greatest in elderly patients.
Conclusions Operative mortality decreases with increasing hospital volume for several cancer resections. However, volume may be most important in patients who are older and at higher risk.
From the Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt (Drs Finlayson, Goodney, and Birkmeyer); Departments of Surgery (Drs Goodney and Birkmeyer) and Community and Family Medicine (Dr Birkmeyer), Dartmouth–Hitchcock Medical Center, Lebanon, NH; Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Dr Birkmeyer); and the Department of Surgery, University of California, San Francisco (Dr Finlayson).
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