HCPLive Network

Hospital Performance Rankings Don’t Capture Cancer Operation Complexity

Although many US hospitals tout quality improvement in surgical outcomes, new research findings released at the national conference of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), held July 13-16 in San Diego, CA, show that taking cancer operation performance into account would deliver a more accurate hospital rating.
 
Noting that “oncologic surgical complexity is not adequately captured by the primary procedure code” that’s used to measure hospitals’ surgical quality outcomes, Jennifer L. Paruch, MD, a general surgery resident at the  University of Chicago Pritzker School of Medicine and an ACS surgical oncology scholar-in-residence, alongside researchers from the Feinberg School of Medicine at Northwestern University, the University of Wisconsin School of Public Health, and the University of California, Los Angeles, examined whether risk predictions and hospital-quality comparisons would change if cancer status was factored into the calculation.
 
“Cancer can affect patients in complex ways, and our goal was to determine whether cancer impacts how different hospitals perform for these operations,” Paruch said in a press release.
 
To do so, the researchers identified hospital patients who underwent colon (n=93,846), rectum (n=13,477), pancreas (n=14,570), liver (n=7,912), esophagus (n=2,226), stomach (n=5,534) or lung (n=3,947) resections — 55 percent of which were performed for cancer indications. Comparing the oncologic and non-oncologic groups, the investigators found that among the cancer patients, the mean ratio of observed complications to expected complications based on patient risk factors and procedure difficulty varied significantly from the mean ratio for non-cancer patients. Of the 309 hospitals treating the patients examined in the study, 127 performed differently depending on cancer status, suggesting that “hospitals that performed well for non-cancer patients may not perform as well for patients with cancer, and vice versa,” the researchers said.
 
“These results demonstrate that in order to get a true picture of a hospital’s quality performance, quality programs must take into consideration patients who have certain diseases, such as cancer,” Clifford Y. Ko, MD, FACS, director of the ACS Division of Research and Optimal Patient Care, said in the press release. “Hospitals aiming to improve cancer care should look specifically at cancer outcomes — independent from non-cancer procedures — because certain aspects of cancer affect surgical outcomes.”  Paruch added that “understanding the factors that contribute to complications is critical to finding ways to prevent complications from occurring.”
 
As the study authors concluded that “surgical complexity adjustment is feasible and improves risk estimation of 30-day postoperative outcomes for colon, rectal, and pancreatic resections for cancer,” they recommended “collecting robust data specific to cancer patients in order to fully understand complications and what factors impact surgical outcomes, as well as to target quality improvement efforts.” 

Further Reading
Researchers have developed a math model that can accurately predict the progression from nephritis to interstitial fibrosis in patients with systemic lupus erythematosus.
Recent studies looking at neural response in patients with fibromyalgia have shown that people with this condition may have hypersensitivity to non-painful stimuli.
Adverse drug events involving psychiatric medications are not uncommon in emergency departments, according to a study published in JAMA Psychiatry.
Researchers at Beth Israel Deaconess Medical Center (BIDMC) reported that proactive monitoring of dose adjustments of infliximab (IFX), one of the 4 anti-TNF-alpha proteins used to treat inflammatory diseases like Crohn’s disease (CD), ulcerative colitis (UC), and inflammatory bowel disease (IBD), could prolong the effectiveness of treatment.
The number of Americans dying from accidental overdoses of opioid analgesics jumped significantly from 1999 to 2011, according to a September data brief published by the US Centers for Disease Control and Prevention's National Center for Health Statistics.
About 14.5 million US cancer survivors are alive today, compared to just three million in 1971, the American Association for Cancer Research reported Tuesday.
The outbreak of the Ebola virus in West Africa is showing no signs of slowing down. As a result, President Barack Obama announced Tuesday that the United States would be getting even more directly involved in the effort to contain the outbreak and prevent it from spreading any further.
More Reading