In a retrospective cohort study reported in the Journal of Clinical Oncology, Mustafa Raoof, MD, MS, and colleagues found that California Medicare Advantage beneficiaries undergoing elective inpatient cancer surgery were less likely than traditional Medicare beneficiaries to have surgery at high-volume hospitals and were at an increased risk of 30-day mortality for some surgery types. However, Medicare Advantage beneficiaries had lower hospital costs.
Study Details
The study used data from the Office of Statewide Health Planning Inpatient Database linked to the California Cancer Registry from 2000 to 2020 on Medicare beneficiaries undergoing surgery for lung, esophageal, stomach, pancreatic, liver, colon, or rectal cancer.
Mustafa Raoof, MD, MS
Key Findings
The analysis included 76,655 Medicare beneficiaries (median age = 74 years, 51% female), of whom 46,494 were traditional Medicare beneficiaries and 30,161 (39%) were Medicare Advantage beneficiaries. Surgery included 31,913 colectomies, 21,691 lung resections, 10,358 proctectomies, 4,604 hepatectomies, 3,639 gastrectomies, 2,895 pancreatectomies, and 1,555 esophagectomies.
Medicare Advantage beneficiaries were less likely (all P < .001) than traditional Medicare beneficiaries to receive care at a high-volume hospital for lung (adjusted risk ratio [aRR] = 0.41), esophagus (aRR = 0.33), stomach (aRR = 0.67), pancreas (aRR = 0.21), liver (aRR = 0.82), and rectal surgery (aRR = 0.88), but more likely to receive care at a high-volume hospital for colon surgery (aRR = 1.31, P < .001).
The 30-day mortality was significantly higher among Medicare Advantage beneficiaries vs traditional Medicare beneficiaries for gastrectomy (adjusted risk difference [ARD] = +1.5%, P = .036), pancreatectomy (ARD = +2.0%, P = .002), and hepatectomy (ARD = +1.4%, P = .04). No significant differences were observed for lung resection (ARD = 0.0%, P = .96), esophagectomy (ARD = +0.1%, P = .93), colectomy (ARD = +0.1%, P = .35), or proctectomy (ARD = +0.3%, P = .24)
Medicare Advantage beneficiaries had significantly lower inflation-adjusted median hospital costs for each surgery type for the index hospitalization and for all hospitalizations within 90 days.
The investigators concluded: “Enrollment in [the] Medicare Advantage plan is associated with lower estimated hospital costs. However, compared with traditional Medicare, Medicare Advantage beneficiaries had lower access to high-volume hospitals and increased 30-day mortality for stomach, pancreas, or liver surgery.”
Dr. Raoof, of the Department of Surgery, City of Hope National Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
