Patients whose procedures for gastrointestinal malignancies were performed by a surgical team at a hospital ranked as one of America’s “best” by U.S. News & World Report were nearly two and half times more likely to survive the operation than those who had the same procedure done at a nonranked hospital. These new research findings were published by Tay et al in the Journal of the American College of Surgeons.
Every year, U.S. News & World Report releases a list ranking the top 50 hospitals for specialty and overall care. These rankings, made available to the public, are based on measures in patient outcomes, patient experience, care-related factors, and expert opinion. The annual issue plays a role in guiding patients and providers to high quality health-care centers. Still, the reliability and accuracy of these rankings for high-risk gastrointestinal surgery is not known.
“Our study demonstrates the U.S. News & World Report ranking is a very appropriate resource,” said study coauthor Ninh T. Nguyen, MD, FACS, Chair of the Department of Surgery at the University of California, Irvine. “Now that we’ve actually done this analysis, we see the ranking does make sense when you look at surgical case volume and other related issues. Patients who seek surgical care at the top-ranked hospitals actually fare better, particularly if they are treated for the complex surgical conditions examined in this study.”
Now that we’ve actually done this analysis, we see the ranking does make sense when you look at surgical case volume and other related issues. Patients who seek surgical care at the top-ranked hospitals actually fare better, particularly if they are treated for the complex surgical conditions examined in this study.— Ninh T. Nguyen, MD, FACS
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Analysis Findings
Using data from the Vizient clinical database, the researchers assessed 6,662 patients who underwent elective esophagectomy, gastrectomy, or pancreatectomy for malignancies in 2018 at U.S. academic centers and their affiliated community hospitals.
Of the 6,662 gastrointestinal cancer operations performed, nearly half (3,054) were performed at 42 top-ranked hospitals, compared with 3,608 performed at 198 nonranked hospitals.
The average annual case volume for these high-risk conditions was four times higher at top-ranked hospitals compared with nonranked hospitals (72 cases vs 18 cases).
Compared with nonranked hospitals, top-ranked hospitals had a much lower in-hospital death rate; specifically, that rate was almost 1% at top-ranked hospitals compared with 2.26% at nonranked centers.
Top-ranked hospitals had a lower in-hospital mortality index compared to nonranked hospitals (0.71 vs 1.53). A score of less than 1 means fewer patients died than expected based on their characteristics and preexisting comorbidities, and a score of more than 1 means more patients died than expected.
For patients who developed serious complications after their operations, top-ranked hospitals had a lower in-hospital death rate compared with nonranked hospitals (8.19% vs 16.79%).
“Anastomotic or pancreatic leaks are a serious postoperative complication that can be associated with an exceedingly high risk of death. Based on our study findings, surgical teams at top-ranked hospitals are likely better at detecting and managing these serious complications, and more likely to save patients from dying from the complication,” said Dr. Nguyen. “For patients, that means if you had your operation performed at a nonranked center, you are 2.35 times more likely to die than if you had it performed at a top-ranked hospital.”
Patient Characteristics a Factor?
After the researchers factored in patient characteristics—such as severity of illness—the death rates were still, on average, lower in the high-volume, ranked hospitals vs nonranked hospitals.
“When we think of top-ranked hospitals, we imagine these hospitals would perform better for patients who are higher-risk, older, or have more comorbidities, but our analysis also examined outcomes based on severity of illness, and we found that even younger, low-risk patients fare better when they go to a top-ranked hospital,” said Dr. Nguyen. “So even if you are healthy, and you’re dealing with a complex [gastrointestinal cancer] requiring surgical resection, you are probably better off also obtaining care at a top-ranked hospital.”
“Deciding where to go for treatment is a collaborative decision that should be made between the patient and their physician. But one of the resources you can use is the annual U.S. News & World Report list,” concluded Dr. Nguyen. “These are complex gastrointestinal operations with a much higher risk of mortality. Therefore, you really want to go to a hospital where the surgical team performs a lot of these operations.”
Disclosure: For full disclosures of the study authors, visit journalacs.org.
