Despite well-established evidence of the correlation between low volumes and worse patient outcomes, more than 600 cancer surgeries in California were performed at hospitals that did only one or two of the procedures a calendar year, a report released Thursday found.
The California HealthCare Foundation evaluated the rates for 11 cancers. The others include brain, breast, colon, liver, lung, pancreas, prostate and rectum. The foundation studied how many surgeries each of the state's hospitals performed in 2014 and found that more than 60% of patients had surgery at low-volume locations even when a high-volume facility was within 50 miles.
Of 354 esophagus cancer surgeries, 19% were performed at hospitals where two or fewer were performed, defined in the report as “low volume.” Of 1,030 stomach cancer operations, 11% were done at low-volume facilities. For bladder cancer surgeries, 9%.
There has been increased focus on the safety impact when facilities do not perform enough volumes of procedures. Several hospitals and health systems announced this year that they would set an annual minimum. In May, U.S. News and World Report announced its “Common Care” rating system, which in part looks at how experienced a hospital is at treating conditions.
The issue bubbled up again in June after a series of pediatric deaths at a Florida hospital. That facility shuttered its pediatric cardiothoracic surgery program two months later. Health quality and policy leaders said hospitals wanting to delve into new areas of surgical specialty should face tougher scrutiny before being allowed to launch a new program.
The analysis from California used ICD-9 diagnostic and procedure codes to measure the volume of surgeries for each type of cancers. The 11 chosen were those for which evidence has shown an association between low volume and higher mortality.
The report also listed other adverse outcomes for each cancer, such as longer lengths of stay after brain and breast cancer surgery, postoperative complications following colon and lung cancer surgery and readmission following prostate cancer surgery.