General surgery

The researches find that the Setting volume thresholds does not guarantee that hospitals will adhere to those standards or that patients will have access to hospitals that do, a study of high-risk cancer surgery patients reveals. Therefore The study was not meant to criticize any professional society or group that supports volume standards for high-risk surgical care; Dr. Kyle Sheetz of the University of Michigan in Ann Arbor told Reuters Health by email. “Our goal was to discuss the tradeoffs that come from volume standards centered on short-term safety.”

High-risk cancer surgery

“They are able to show, as many have before; that volume still matters – just at higher numbers;” he said. “However, if we were to move the volume standard up, so few hospitals would meet it that it would be impractical.” Dr. Sheetz and colleagues reviewed Medicare claims for 516,392 patients undergoing pancreatic, esophageal, rectal, or lung resection between 2005 – 2016. They analyzed 30-day outcomes of high-risk cancer surgery in hospitals meeting and not meeting the minimum volume standards set by The Leapfrog Group, a nonprofit organization that reports on hospital performance.

There were 47,318 pancreatic resections; 29,812 esophageal resections; 116,383 rectal resections; and 322,879 lung resections. The mean patient age was 73. As reported online August 14 in JAMA Surgery; outcomes improved over time, regardless of whether hospitals met minimum volume standards. Overall; from 2005-2016, 30-day mortality decreased after pancreatic resection from 5.5% to 4.8%; after esophageal resection; from 6.7% to 5.0%; after rectal resection, from 3.6% to 2.7%; and after lung resection, from 4.2% to 2.7%.

Rectal cancer resections

Throughout the study period, there were no statistically significant differences in risk-adjusted 30-day mortality between hospitals meeting and not meeting the volume standards for esophageal, lung, and rectal cancer resections. Mortality rates after pancreatic resection were consistently lower at hospitals meeting the volume standard; although the differences were not statistically significant. For example, in 2016, risk-adjusted mortality rates for hospitals meeting the volume standard were 3.8% compared with 5.7% for hospitals that did not.

Complication rates also showed continued trends toward better outcomes but no differences between hospitals meeting and not meeting the Leapfrog volume standard for any procedure. While an increasing majority of patients underwent surgery in hospitals meeting the Leapfrog volume standards over time, the overall proportion of hospitals meeting the standards in 2016 was low, ranging from 5.6% for esophageal resection to 23.3% for pancreatic resection.