Relationship between hospital volume and short-term outcomes: a nationwide population-based study including 75,280 rectal cancer surgical procedures

Pucciarelli, Salvatore; Zorzi, Manuel; Gennaro, Nicola; Marchegiani, Francesco; Barina, Andrea; Zuin, M.; Perin, Alessandra; Bergamo, Francesca; Boso, Caterina; Urso, Emanuele Damiano Luca; Frambach, P.; Corti, Maria Chiara

doi:10.18632/oncotarget.24699

Cited by 14 publications

(13 citation statements)

References 36 publications

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“…Some 18·4 per cent of all operations were emergency procedures, an unexpectedly high proportion. These cases will increase the expertise of surgeons in individual hospitals, but could have biased the mortality analysis as they were not equally distributed across the quintiles.…”

Section: Discussionmentioning

confidence: 99%

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

et al. 2020

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Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.

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Section: Discussionmentioning

confidence: 99%

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

et al. 2020

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“…This finding can be the result of a more accurate patients selection and a better ability to rescue patients after surgery, since the mortality of patients in high-volume hospital was found to be almost half compared to low-volume centers (0.9% vs. 1.6%, p < 0.001). To confirm the hypothesis of better patients selection, in a previous study using the same cohort of patients, we showed that patients admitted to low-volume hospitals were more likely to be older (p < 0.001), have a worse Charlson Comorbidity Index (p < 0.001), have a higher rate of stoma creation (p < 0.001), and being treated with an open approach (p < 0.001) [11]. Based on these findings it is important to implement a program of centralization of care and a system of evaluation of patient care nationwide, aiming to improve patient selection, perioperative management and quality standards.…”

Section: Discussionmentioning

confidence: 56%

“…Hospital volume has been widely used to characterize the quality of care, mostly defined in terms of in hospital mortality, length of stay and readmission [11]. FTR has been recently introduced as a metric of quality of care and researchers correlated it with hospital volume and type (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital volume and postoperative outcome has been a binomial investigated among different surgical specialties, including liver [1], esophageal [2,3], cardiac [4,5], lung [6], pancreatic [7], colorectal [8], complex gastrointestinal [9], and ovarian [10] surgery. In a recent study we showed a strong and independent association between hospital volume and short-term outcomes, such as in-hospital mortality, 30-day readmission and length of stay, among patients undergoing rectal surgery [11]. However, the mechanism underlying this association remains unclear.…”

Section: Introductionmentioning

confidence: 91%

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Failure-to-Rescue as a Source of Variation in Hospital Mortality after Rectal Surgery: the Italian Experience

Spolverato

Gennaro

Zorzi

et al. 2018

Journal of the American College of Surgeons

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Introduction: Failure to rescue (FTR) patients from postoperative complications could contribute to the variability in surgical mortality seen among hospitals with different volumes. We sought to examine the impact of complications and FTR on mortality following rectal surgery. Methods: The National Italian Hospital Discharge Dataset allowed to identify 75,280 patients who underwent rectal surgery between 2002 and 2014. Hospital volume was stratified into tertiles. Rates of major complications, FTR from complications and mortality following rectal surgery were compared. Results: During the study period, both the incidence of complications (2002, 23.7% versus 2014, 21.2%), and FTR decreased overtime (2002, 6.9% versus 2014, 3.8%) (both P < 0.001). The complication rate was 24.4% in low-, 21.6% in intermediate-and 20.4% in high-volume hospitals (P < 0.001). Complications were less common in minimally invasive surgery (MIS) versus open cases (18.2% versus 23.2%; P < 0.001). The most frequent complications included prolonged ileus or small bowel obstruction (5.3%), and anemia requiring blood transfusions (5.3%). The rate of FTR was 5.5%, 5.6% and 3.7% for low-, intermediate-and high-volume hospitals, respectively (P < 0.001). FTR after MIS was 2.6% vs. 5.5% after open surgery (P < 0.001). After accounting for patient and hospital characteristics, patients treated at low-volume hospitals were 23% more likely to die after a complication, compared to patients at high-volume hospitals (OR 1.23, 95%CI 1.13e1.33). Conclusions: Hospital volume is the strongest predictor of complication and FTR. The reduction in mortality in high-volume hospitals could be determined by the better ability to rescue patients. These findings support the centralization policy of rectal cancer treatment.

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“…The average LOS varies according to the type of procedure considered. Pucciarelli et al [9] analysed 75280 patients submitted to cancer colorectal procedures and the median LOS was 13 days [9], while Nassour et al [10] reported a median LOS of 11.5 days for robotic and 11.8 days for laparoscopic pancreaticoduodenectomy [10]. Our higher ALOS when compared to the literature is probably a consequence of the complexity of our co-managed patients: oncological surgical patients with high risk procedures and their possible complications, prolonged recovery and multiple medical comorbidities.…”

Section: Discussionmentioning

confidence: 78%

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2018

JTMP

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Hospital Medicine care dedicated to cancer patients has grown in recent years. The presence of hospitalists in the co-management of surgical patients has been associated with decreasing Length of Stay (LOS). This study aims to evaluate the impact of hospitalist team co-management on length of stay in an oncological surgical population. This is a retrospective analyze of the patients assisted by the Hospitalist Team from 2013 through 2016. The primary outcome was the Average Length of Stay (ALOS). The time from admission to the first hospitalist evaluation was significantly smaller in the group with a LOS less than 16 days (p<0.0001) and the inverse relationship was also true: the LOS was higher in the group evaluated by the hospitalist for the first time only after 3 days from admission (Late co-management) (p<0.0001). Early Hospital Medicine team co-management of cancer surgical patients is associated with lower LOS.

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Relationship between hospital volume and short-term outcomes: a nationwide population-based study including 75,280 rectal cancer surgical procedures

Cited by 14 publications

References 36 publications

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

Failure-to-Rescue as a Source of Variation in Hospital Mortality after Rectal Surgery: the Italian Experience

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