Top-ranked cancer centers superior to affiliates in survival outcomes
Click Here to Manage Email Alerts
Patients who undergo complex cancer surgery at top-ranked cancer centers achieve better survival outcomes than patients who undergo such treatments at those centers’ affiliate hospitals, according to research published in JAMA Network Open.
“We noted a trend that hospitals with particularly strong reputations for excellent care were increasingly forming affiliations with hospitals in the community. Through survey studies, we learned that many people believe that all hospitals that share the name of a trusted hospital offer the same excellent care,” Daniel J. Boffa, MD, associate professor of thoracic surgery at Yale School of Medicine, told Healio. “We wanted to understand care across networks that form around top-ranked hospitals to both evaluate public perceptions and to establish a baseline of treatment outcomes within networks. We suspected the network infrastructure could be leveraged to improve care at all hospitals in the networks.”
Investigators used data from the unabridged version of the National Cancer Database to compare short- and long-term survival outcomes among 119,834 adults who underwent complex surgery for esophageal, gastric, lung, pancreatic, colorectal or bladder cancer between 2013 and 2016.
The researchers compared outcomes of patients who underwent surgery across 56 hospitals ranked at least once during the study period among the top 50 cancer hospitals by U.S. News and World Report (n = 79,981; median age, 66 years; 54.9%, men) with outcomes of patients who underwent surgery at 206 affiliates of top-ranked hospitals (n = 39,853; median age, 69 years; 50% men).
Results showed patients who underwent surgery at an affiliate hospital had higher adjusted perioperative 90-day mortality than those who underwent surgery at top-ranked hospitals (OR = 1.67; 95% CI, 1.49-1.89).
Mortality odds varied based on the procedure, ranging from an OR of 1.23 (95% CI, 0.78-1.96) for proctectomy to an OR of 2.72 (OR = 2.72; 95% CI, 1.57-4.72) for total colectomy.
Adjusted analyses that used parametric survival models showed patients who underwent surgery at affiliated hospitals achieved significantly poorer survival than patients who underwent surgery at top-ranked hospitals (time ratio, 0.77; 95% CI, 0.72-0.83).
“Patients should not assume that every hospital within a network around a top-ranked hospital achieves the same outcomes, and they should investigate the outcomes at any hospital they are considering for their care,” Boffa told Healio. “We believe that these findings represent a tremendous opportunity to improve care, because some of the country’s best hospitals are connected to hospitals with room to improve. These connections are critical to allowing hospitals to help each other to address safety and quality shortcomings.”
Although both short- and long-term survival favored the top-ranked hospitals, Boffa noted that several practices associated with quality — such as completely removing all of the tumors and avoiding delays in care — were similar at or favored affiliate hospitals.
“This is just the beginning,” Boffa told Healio. “The next chapter is finding ways to help hospitals in these networks help each other address gaps in safety and quality.”
For more information:
Daniel J. Boffa, MD, can be reached at Yale School of Medicine, Box 208062, New Haven, CT 06520; email: daniel.boffa@yale.edu.
Collapse
Click Here to Manage Email Alerts