New York, N.Y., November 23, 1998 -- There is increasing evidence that one of the first questions a cancer patient should ask his or her surgeon is, "How often do you perform this procedure?" That question should be followed up with, "How often is the procedure performed in this hospital?"
In a study published in the November 25 Journal of the American Medical Association, researchers from Memorial Sloan-Kettering Cancer Center found that mortality rates were 40 to 80% lower in hospitals that had the most experience performing a particular surgical procedure.
"Surgical management of a patient with cancer is learned and refined by practice and experience," said Dr. Murray Brennan, chairman of the Department of Surgery at Memorial Sloan-Kettering and a co-author of the paper. "The more experience the surgeon has in doing a specific procedure and managing patients with a specific cancer, the better the patient's chances that he or she will have a better outcome after the operation."
The researchers looked at outcomes for cancer patients age 65 years or older at diagnosis by analyzing the Surveillance, Epidemiology and End Results (SEER) Medicare linked database from 1984 to 1993. It consists of all cases of cancer in several defined geographic populations and encompasses 97% of all individuals 65 years of age or older. They chose five of the most difficult cancer operations including pancreatectomy, esophagectomy, pneumonectomy, hepatic resection, and pelvic exeneration. The researchers examined the database to identify a cohort of patients with the same type of cancer who were at the same stage of disease and had the same operation within two months of diagnosis. They then looked at the 30-day mortality rate for each procedure and compared the rates by hospital volume. In every instance, they found that hospitals with a high volume of surgery for selected procedures had a substantially lower surgical mortality rate than hospitals where the surgical team had limited experience with the procedures.
The results showed similar trends for each type of surgery. The relationship between outcome and volume was consistently demonstrated with mortality rates lower in the high volume hospitals. After 30 days, 12.9% of the patients who had a pancreatectomy performed in hospitals with a low volume died compared to 7.7% in hospitals with middle range of volume and 5.8% in a hospitals that had high volume. The results for esophagectomy were even more striking. The low volume hospitals had a 30-day mortality rate of 17.3% while the patient in high volume hospitals had only a 3.4% mortality rate.
"Our study provides evidence in support of a growing literature that specialist cancer care can significantly increase a patient's chance of survival," said Dr. Colin Begg, the study's first author, who is Chairman of the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering. "Patients who are potential candidates for complicated cancer operations should be made aware of these trends when selecting a hospital."
Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer. Throughout its long distinguished history, the Center has played a leadership role in defining the standard of care for patients with cancer. In 1998, Memorial Sloan-Kettering was named the nation's best cancer care center for the sixth consecutive year by U.S. News & World Report.
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Journal
JAMA