Assessment of variation in 30‐day mortality following cancer surgeries among older adults across US hospitals

Abstract

Background While public reporting of surgical outcomes for noncancer conditions is common, cancer surgeries have generally been excluded. This is true despite numerous studies showing outcomes to differ between hospitals based on their characteristics. Our objective was to assess whether three prerequisites for quality assessment and reporting are present for 30‐day mortality after cancer surgery: low burden for timely reporting, hospital variation, and potential for public health gains. Study Design We used Fee‐for‐Service (FFS) Medicare claims to examine the extent of variation in 30‐day cancer surgical mortality between 3860 US hospitals. We included 340 489 surgeries for 12 cancer types for FFS Medicare beneficiaries aged ≥66 years, 2011‐2013. Hierarchical mixed‐effects logistic regression models adjusted for patient and hospital characteristics and with a random hospital effect were fit to obtain hospital‐specific risk‐standardized mortality rates (RSMRs) and 99% confidence intervals (CI). We calculated a hospital odds ratio to describe the difference in mortality risk for a hospital above vs below average quality and estimated the potential mortality reduction. Results The median number of cancer surgeries per hospital was 34. The median RSMR overall was 2.41% (99% CI 2.28%, 2.66%). In aggregate and for most cancers, variation between hospitals exceeded that due to differences in patient and hospital characteristics. For individual cancers, relative differences exceeded 20% in mortality risk between patients undergoing surgery at a hospital below vs above average quality, with the potential for an estimated 500 deaths prevented annually given hypothetical improvements. Conclusion Quality measurement and reporting of 30‐day mortality for cancer surgery is worthy of consideration.

Current therapeutic options for gastric adenocarcinoma

“…The studies reported the gastric cancer risk correlated with body mass index (BMI) levels in a U-shaped manner, particularly in populations not infected by H. pylori ( Jang et al, 2019 ). The studies have revealed that the cancer surgical death rate differs highly which can be illustrated fortuitously in a treated subset of patients and that accordingly; this variation is the main reason for increased and futile mortality ( Lipitz-Snyderman et al, 2020 ). The quality measurement may be beneficial for the patients to decide value‐based compensatory programs, policy evaluation, and quality battering initiatives with the latest goal of developing patient outcomes ( Lipitz-Snyderman et al, 2020 ).…”

“…The studies have revealed that the cancer surgical death rate differs highly which can be illustrated fortuitously in a treated subset of patients and that accordingly; this variation is the main reason for increased and futile mortality ( Lipitz-Snyderman et al, 2020 ). The quality measurement may be beneficial for the patients to decide value‐based compensatory programs, policy evaluation, and quality battering initiatives with the latest goal of developing patient outcomes ( Lipitz-Snyderman et al, 2020 ). As the generations change, clinicians are elevating being challenged with the difficulties in treating aged patients, as the number of old aged gastric cancer patients has been rising ( J.I.…”

“…Gastric cancer (GC) is a death-dealing disorder leading to have an intimidating impact on global health. Despite a substantial decrease in the rate of incidence over the last few years, gastric cancer still remains the fourth most typical form of cancer, with a recent report of as many as 1,033,701 new cases (in 2018), 782,685 deaths and thus remains as the second leading cause of cancer-related deaths worldwide ( Lipitz-Snyderman et al, 2020 ). The decline in the occurrences of GC are mainly due to improved nutrition, food preservation, pre-symptomatic diagnosis, treatment, and administration of therapeutics.…”

Direct and indirect effects of COVID-19 on short-term mortality of breast cancer patients

“…Firstly, it aligns with the existing COVID-19 literature, allowing us to place our results in the appropriate context [ 11 ]. Secondly, it is a recognized indicator for assessing healthcare quality [ 12 ], taking into consideration factors such as appropriate procedure performance and complications [ 13 ]. Our analysis showed that there was an increase in 30-day mortality in 2020, not only among infected patients as expected, but also among non-infected patients.…”

“…Whether or not short-term mortality after the COVID-19 outbreak was due to individual/tumor-related factors, treatment timeliness/clinical decision making or rather misdiagnosed COVID-19 [ 14 ], our data are interesting in several aspects. First, they expand and are in line with recently reviewed studies suggesting that every month delayed in cancer treatment can raise risk of death by around 10% [ 15 ].…”