Racial and Socioeconomic Differences in the Use of High-Volume Commission on Cancer-Accredited Hospitals for Cancer Surgery in the United States

• Published in: Annals of surgical oncology 2018-05, Vol.25 (5), p.1116-1125
• Main Authors: Wasif, Nabil, Etzioni, David, Habermann, Elizabeth B., Mathur, Amit, Pockaj, Barbara A., Gray, Richard J., Chang, Yu-Hui
• Format: Article
• Language: English
• Subjects: Accreditation; African Americans - statistics & numerical data; Aged; Aged, 80 and over; Cancer surgery; Colon cancer; Colonic Neoplasms - surgery; Colorectal cancer; Databases, Factual; Educational attainment; Educational Status; Esophageal cancer; Esophageal Neoplasms - surgery; Esophagus; European Continental Ancestry Group - statistics & numerical data; Female; Health Services Accessibility; Health Services Research and Global Oncology; Hospitals; Hospitals, High-Volume - statistics & numerical data; Hospitals, High-Volume - trends; Humans; Income; Liver; Liver cancer; Liver Neoplasms - surgery; Male; Medically Uninsured - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - surgery; Oncology; Pancreatic cancer; Pancreatic Neoplasms - surgery; Patients; Postal codes; Rural Population - statistics & numerical data; Surgery; Surgical Oncology; United States; Urban Population - statistics & numerical data
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6374-0

Background Although major cancer surgery at a high-volume hospital is associated with lower postoperative mortality, the use of such hospitals may not be equally distributed. Objective Our aim was to study socioeconomic and racial differences in cancer surgery at Commission on Cancer (CoC)-accredited high-volume hospitals. Methods The National Cancer Database (NCDB) was used to identify patients undergoing surgery for colon, esophageal, liver, and pancreatic cancer from 2003 to 2012. Annual hospital volume for each cancer was categorized using quartiles of patient volume. Patient-level predictors of surgery at a high-volume hospital, trends in the use of a high-volume hospital, and adjusted likelihood of surgery at a high-volume hospital in 2012 versus 2003 were analyzed. Results African American patients were less likely to undergo surgery at a high-volume hospital for esophageal (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.49–0.73) and pancreatic cancer (OR 0.83, 95% CI 0.74–0.92), while uninsured patients and those residing in low educational attainment zip codes were less likely to undergo surgery at a high-volume hospital for esophageal, liver, and pancreatic cancer. In 2012, African Americans, uninsured patients, and those from low educational attainment zip codes were no more likely to undergo surgery at a high-volume hospital than in 2003 for any cancer type. These differences were not seen in colon cancer patients, for whom significant regionalization was not seen. Conclusions Differences in the use of CoC-accredited high-volume hospitals for major cancer surgery were seen nationwide and persisted over the duration of the study. Strategies to increase referrals and/or access to high-volume hospitals for African American and socioeconomically disadvantaged patients should be explored.