PHILADELPHIA — An analysis of more than 5,000 rectal cancer patients in New York state linked superior outcomes with high-volume hospitals, compared with low-volume institutions, Salvatore Savatta, M.D., reported at the annual meeting of the American Society of Colon and Rectal Surgeons.
The study found that patients treated at high-volume hospitals were less likely to die in the hospital, had fewer medical complications, and had shorter lengths of stay, Dr. Savatta said.
In addition, patients who were older, African American, and on Medicaid were more likely to have their rectal surgery done at low-volume hospitals, said Dr. Savatta, of Memorial Sloan-Kettering Cancer Center in New York. This trend may be associated with the fact that these patients tend to have a lower socioeconomic status, he said.
“Patients who wind up in hospitals that don't do as many surgeries may not be plugged into the medical system very well,” Dr. Savatta suggested.
The analysis included all patients who had surgery for stage I-III rectal cancer in New York state during 1998–2002. The demographic, hospital volume, and outcome data were collected by the New York State Department of Health through the Statewide Planning and Research Cooperative System.
During this period, 5,143 patients had rectal surgery for cancer at one of 209 hospitals in New York. The hospitals were stratified into four groups based on the number of procedures performed: very low volume, low volume, medium volume, and high volume. (See table.)
The distribution of patients by gender and by cancer stage was similar in all four hospital categories. But patients in the low-volume hospitals were on average significantly older than those in the high-volume hospitals. In addition, the average proportion of African American patients and the percentage of patients on Medicaid were higher in the very-low-volume hospitals, compared with the high-volume hospitals.
Patients treated in the very-low-volume and low-volume hospitals also had significantly higher comorbidity, in-hospital mortality, and rates of acute admissions, medical complications, and average length of stay, compared with patients in the high-volume hospitals, Dr. Savatta said.
Some outcome differences were independent of the demographic factors. For example, in-hospital mortality remained significantly lower in the high-volume hospitals compared with the very-low-volume hospitals even after adjustment for baseline demographic differences. But the difference in hospital length of stay was no longer statistically significant after adjustment for demographic differences, he added.