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Assessment of variation in 30-day mortality following cancer surgeries among older adults across US hospitals.
Cancer Medicine ( IF 2.9 ) Pub Date : 2020-01-09 , DOI: 10.1002/cam4.2800 Allison Lipitz-Snyderman 1 , Jessica A Lavery 2 , Peter B Bach 1 , Diane G Li 1 , Annie Yang 1 , Vivian E Strong 3 , Ashley Russo 3 , Katherine S Panageas 2
Cancer Medicine ( IF 2.9 ) Pub Date : 2020-01-09 , DOI: 10.1002/cam4.2800 Allison Lipitz-Snyderman 1 , Jessica A Lavery 2 , Peter B Bach 1 , Diane G Li 1 , Annie Yang 1 , Vivian E Strong 3 , Ashley Russo 3 , Katherine S Panageas 2
Affiliation
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BACKGROUND
While public reporting of surgical outcomes for noncancer conditions is common, cancer surgeries have generally been excluded. This is true despite numerous studies showing outcomes to differ between hospitals based on their characteristics. Our objective was to assess whether three prerequisites for quality assessment and reporting are present for 30-day mortality after cancer surgery: low burden for timely reporting, hospital variation, and potential for public health gains.
STUDY DESIGN
We used Fee-for-Service (FFS) Medicare claims to examine the extent of variation in 30-day cancer surgical mortality between 3860 US hospitals. We included 340 489 surgeries for 12 cancer types for FFS Medicare beneficiaries aged ≥66 years, 2011-2013. Hierarchical mixed-effects logistic regression models adjusted for patient and hospital characteristics and with a random hospital effect were fit to obtain hospital-specific risk-standardized mortality rates (RSMRs) and 99% confidence intervals (CI). We calculated a hospital odds ratio to describe the difference in mortality risk for a hospital above vs below average quality and estimated the potential mortality reduction.
RESULTS
The median number of cancer surgeries per hospital was 34. The median RSMR overall was 2.41% (99% CI 2.28%, 2.66%). In aggregate and for most cancers, variation between hospitals exceeded that due to differences in patient and hospital characteristics. For individual cancers, relative differences exceeded 20% in mortality risk between patients undergoing surgery at a hospital below vs above average quality, with the potential for an estimated 500 deaths prevented annually given hypothetical improvements.
CONCLUSION
Quality measurement and reporting of 30-day mortality for cancer surgery is worthy of consideration.
中文翻译：
评估美国各医院中老年人进行癌症手术后30天死亡率的变化。
背景技术尽管公开报告非癌症疾病的手术结果是普遍的，但癌症手术通常被排除在外。尽管有许多研究表明医院的结局因其特征而异，但事实仍然如此。我们的目标是评估在进行癌症手术后30天死亡率中是否存在进行质量评估和报告的三个先决条件：及时报告的负担低，医院变化大，公共卫生收益潜力大。研究设计我们使用了按服务付费（FFS）的Medicare索赔来检查3860家美国医院之间30天癌症手术死亡率的差异程度。我们纳入了2011-2013年针对年龄≥66岁的FFS Medicare受益人的12种癌症类型的340489例手术。调整了针对患者和医院特征并具有随机医院效应的分层混合效应逻辑回归模型，以获得特定于医院的风险标准化死亡率（RSMR）和99％置信区间（CI）。我们计算了医院的优势比，以描述高于或低于平均质量的医院死亡风险的差异，并估计潜在的死亡率降低。结果每家医院的癌症手术中位数为34。RSMR中位数总体为2.41％（99％CI为2.28％，2.66％）。总体而言，对于大多数癌症，由于患者和医院特征的差异，医院之间的差异超过了差异。对于个别癌症，在质量低于或高于平均水平的医院接受手术的患者之间，死亡风险的相对差异超过20％，假设有假想的改善，那么每年估计有500人死亡的可能性得到了预防。结论质量测量和癌症手术30天死亡率的报告值得考虑。
更新日期：2020-01-11
中文翻译：
评估美国各医院中老年人进行癌症手术后30天死亡率的变化。
背景技术尽管公开报告非癌症疾病的手术结果是普遍的，但癌症手术通常被排除在外。尽管有许多研究表明医院的结局因其特征而异，但事实仍然如此。我们的目标是评估在进行癌症手术后30天死亡率中是否存在进行质量评估和报告的三个先决条件：及时报告的负担低，医院变化大，公共卫生收益潜力大。研究设计我们使用了按服务付费（FFS）的Medicare索赔来检查3860家美国医院之间30天癌症手术死亡率的差异程度。我们纳入了2011-2013年针对年龄≥66岁的FFS Medicare受益人的12种癌症类型的340489例手术。调整了针对患者和医院特征并具有随机医院效应的分层混合效应逻辑回归模型，以获得特定于医院的风险标准化死亡率（RSMR）和99％置信区间（CI）。我们计算了医院的优势比，以描述高于或低于平均质量的医院死亡风险的差异，并估计潜在的死亡率降低。结果每家医院的癌症手术中位数为34。RSMR中位数总体为2.41％（99％CI为2.28％，2.66％）。总体而言，对于大多数癌症，由于患者和医院特征的差异，医院之间的差异超过了差异。对于个别癌症，在质量低于或高于平均水平的医院接受手术的患者之间，死亡风险的相对差异超过20％，假设有假想的改善，那么每年估计有500人死亡的可能性得到了预防。结论质量测量和癌症手术30天死亡率的报告值得考虑。
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