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Hospital Volume Imperfect Gauge of Cancer Surgery Outcomes

Last Updated: May 04, 2009.

Review finds inconsistent results, questions validity of numbers.

MONDAY, May 4 (HealthDay News) -- Looking at the number of cancer surgeries performed at a hospital to determine where patients will receive the best care is a useful, but imperfect, method, say Australian researchers who reviewed 101 studies on hospital case volume and patient outcomes.

The studies included more than 1 million patients with esophageal, gastric, hepatic, pancreatic, colon or rectal cancer.

The review authors found a significant association between hospital case volume and death risk for five of the six cancer types. Overall, each doubling of hospital case volume decreased the risk of perioperative (around the time of surgery) death by more than 10 percent.

Between 10 and 50 patients per year, depending on the cancer type, need to be moved from a low-volume to a high-volume hospital to prevent one additional volume-associated perioperative death, calculated the researchers at the University of Melbourne and Royal Melbourne Hospital.

However, the review authors noted that about one-third of the studies failed to find a significant link between hospital volume and death risk. They added that a lack of consistent results from individual studies calls into question the validity of using hospital volume to measure quality of care.

"On the basis of mortality outcomes alone, it appears prudent to support volume-based referral and high-volume centers," the researchers wrote.

However, a surgeon's individual case volume may also affect patient outcomes. For example, a large hospital where many surgeons each perform a small number of operations may have a higher death rate than a small hospital where one or two surgeons do only one type of operation.

The review authors concluded that there are "clearly some low-volume providers who get good results, and therefore referral to relatively low-volume providers should be supported if good outcomes can be demonstrated by process measures or by risk-adjusted outcomes, especially if there are compelling personal or medical reasons for the patient to be treated close to home."

The review appears in the current issue of CA: A Cancer Journal for Clinicians.

More information

The American Cancer Society has more about cancer surgery.

SOURCE: American Cancer Society, news release, May 4, 2009

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