More risky cancer surgery complex among affiliates of the highest ranked hospitals

A new study shows that higher mortality rates have been observed among patients undergoing complex cancer surgeries in affiliated hospitals compared to the first-tier centers with which they share their brand.

People who underwent colectomy, esophagectomy, gastrectomy, pulmonary lobectomy, and pancreatoduodenectomy (Whipple) in networked hospitals had a higher risk of death in 90 days compared with those who had undergone surgery. flagship hospital (OR 1.40, 95% CI 1.23-1.59). , P<0.001), said Daniel J. Boffa, MD, of the Yale School of Medicine in New Haven, Connecticut, and his colleagues.

"This is not totally surprising, as affiliated hospitals are generally smaller, less likely to be teaching hospitals and perform complex surgical procedures with less frequency (lower volume) than in the United States. the first-tier hospitals, "they wrote. JAMA Network open now. "At this point, inclusion of hospital characteristics in adjusted models has attenuated (but did not eliminate) mortality differences at 90 days."

The risk of death within 90 days was highest in patients undergoing gastrectomy in an affiliated hospital (OR 2.04, 95% CI 1.41-2.95, P<0.001), followed by:

• Pancreaticoduodenectomy (OR 1.59, 95% CI 1.12-2.24, P<0.009)
• Esophagectomy (OR 1.48, 95% CI 0.98-2.22, P<0.06)
• Lobectomy (OR 1.34, 95% CI 1.03-1.74, P<0.03)
• Colectomy (OR 1.32, 95% CI: 1.12-1.56, P= 0.001)

For perioperative safety, 79.6% of flagship hospitals outperformed the national average, compared with only 34.7% of affiliated hospitals.

Previous studies suggest that patients are likely to be heavily influenced by the affiliation status of a hospital, the authors explained. One study showed that respondents prefer complex cancer care at an American hospital affiliated with a leading cancer center. Another study found that half of them thought that first-tier hospitals and their affiliates offered care of similar quality and safety.

"Nearly a third of respondents who were willing to travel an extra hour to get cancer surgery complex in a first-rate cancer hospital have changed their preference for a smaller local hospital," he said. shared an affiliation with a hospital for first-rate cancer, "they wrote. "As a result, it is feared that part of the American public may misinterpret the sharing of the mark as indicating equal attention."

To conduct their cross-sectional badysis, Boffa's group examined the results of 29,228 Medicare patients who underwent complex surgery for cancers of the colon, esophagus, lung, pancreas and stomach. 2013 to 2016 in the main cancer hospitals, clbadified by US News and World Report, as well as the hospitals in their network. The authors explained that in 2016, the 59 highest ranked cancer hospitals and their affiliates performed nearly one-third of the complex cancer surgeries for Medicare beneficiaries.

In a commentary that accompanied the research, Lesly A. Dossett, MD, MPH, of the University of Michigan at Ann Arbor, wrote that "in general, affiliation to a network n & # 39; 39; has not lived up to its theoretical potential for improving the quality of operated patients. "

But she cautioned that the study only badessed a small portion of cancer care and noted that the results do not apply to less-complex operations for bad cancers, cancer, and cancer. prostate, skin or thyroid at the early stage. She also pointed out several important limitations of the study. Researchers have not adapted to other types of cancer treatment, such as chemotherapy and radiotherapy, nor to the treatment of "advanced non-operable cancer, screening, surveillance and survival care" , she said.

"In addition, it is probably impossible or impossible for all patients in the area served by the lighthouse to be treated in this center," Dossett wrote. "Understanding which patients are best treated at the flagship level and who can receive high quality care from the smallest affiliate is a first step."

2019-04-12T17: 45: 00-0400