Outcomes/Effectiveness Research

No consistent association found between volume or quality and outcomes of complex surgeries for cancer

The link between high-volume surgery and improved surgical outcomes has become the focus of payer-driven proposals to regionalize care to high-volume centers. Yet a research team headed by Andrew D. Auerbach, M.D., M.P.H., of the University of California, San Francisco, found no consistent association between higher hospital or surgeon volume and mortality, readmission, length of stay, or costs for complex cancer surgery. Neither was there any consistent association between individual quality measures and readmission, mortality, and other outcomes. Lower overall adherence to quality-of-care measures was associated with higher costs and longer hospital stays, but not improved outcomes.

The study included 14,170 patients 18 years or older who were operated on for cancer by 1,629 physicians at 266 U.S. hospitals during the period 2003-2005. The procedures included pneumonectomy, esophagectomy, pancreatectomy, and pelvic surgery. Quality measures included whether antimicrobials were used to prevent surgical site infection on the operative day, whether an antimicrobial was continued inappropriately past the first day after surgery, and whether appropriate strategies were used to prevent venous thromboembolism on the operative day.

The findings suggest that quality improvement efforts aimed at improving the reliability of systems that provide care for cancer surgery patients can have a substantial impact on costs of care. This study was supported by the Agency for Healthcare Research and Quality (HS11416).

See "The relationship between case volume, care quality, and outcomes of complex cancer surgery," by Dr. Auerbach, Judith Maselli, M.S.P.H., Jonathan Carter, M.D., and others in the Journal of the American College of Surgery 211, pp. 601-608, 2010.

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