Has Recognition of the Relationship Between Mortality and Hospital Volume for Major Cancer Surgery in California Made any Difference? Analysis of the Last Decade
*Warren J Gasper*1, *Piero M Fisichella*2, *David Glidden*1, Lawrence W Way1, Marco G Patti3
1University of California San Francisco, San Francisco, CA;2Loyola University, Maywood, IL;3University of Chicago, Chicago, IL
In the 1990’s, we showed that in California the mortality for esophageal, pancreatic, and hepatic resections for cancer was inversely related to the hospital volume. It is not known if this information brought about a change in the referral pattern and improvement in outcome.
Objectives: The goals of this study were to determine if in the 10 year period after our initial analysis: a) the operative mortality decreased; and b) there was a change in the referral pattern of patients with esophageal, pancreatic and hepatic cancers to high volume centers in California.
Hospital discharge data were obtained from the California Office of Statewide Health Planning and Development for 9720 patients undergoing resection for cancer in California between 1995 and 2004: esophageal, 2404 patients; pancreatic, 5294 patients; and hepatic, 2022 patients. Hospitals were grouped by volume for each operative category and mortality rates calculated. A logistic regression analysis was used to determine the relationship between hospital volume and risk adjusted mortality. Data were compared to published results from 1990-1994.
|High volume center mortality (>6 resections/yr)||6%||4.9%||4.4%|
|Patients treated at high volume centers||273 (17%)*†||297 (25%)*§||408 (34%)†§|
|High volume center mortality (>10 resections/yr)||3.5%||1.8%||1.5%|
|Patients treated at high volume centers||143 (8%)*†||422 (19%)*§||927 (31%)†§|
|High volume center mortality (>3 resections/yr)||9.4%||4.3%||2.7%|
|Patients treated at high volume centers||146 (29%)*†||307 (47%))*§||928 (68%)†§|
* p<0.05, † p<0.05, § p<0.05
The operative mortality of esophageal, pancreatic, and hepatic resection for cancer in California decreased significantly since our initial analysis of the 1990-1994 period. The number of patients referred to high volume centers for resection of esophageal, pancreatic or liver malignancy increased significantly.