Interpreting the Volume-Outcome Relationship in the Context of Cancer Care (2001) / Chapter Skim
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Appendix A: Volume and Outcome in Cancer Surgery
Appendix A: Volume and Outcome in Cancer Surgery
Pages 13-32
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From page 13... ...
In total, 11 papers studied pancreatic resection, five studied colorectal resection, three studied esophagectomy, three studied lung resection, and two studied breast surgery (see attached summaries)
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From page 14... ...
The study with the lowest quality score had a small sample that was not representative of the entire population and did not perform any risk adjustment (Wade, 19964. The study with the highest quality score had a large, representative sample, and it examined physician volume, hospital volume, and the interaction between the two (Lieberman, 1995~.
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All studies performed some risk adjustment, and only one utilized clinical data (Beg", 1998~. No study evaluated clinical processes such as operative approach (abdominal versus thoracoabdominal)
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studied 12,861 cases of breast cancer surgery performed by 180 surgeons in the Yorkshire Regional Health Authority area from 1979 to 1988. Risk adjustment included age, extent of disease, tumor grade, socioeconomic status, date of treatment, and type of therapy (surgery, radiation, chemotherapy, hormone therapy, surgery alone)
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From page 17... ...
No significant relationship between surgeon volume and outcome was found Begg and colleagues examined 1,375 pneumonectomies performed on Medicare patients at 313 hospitals in the United States. They utilized clinical data for risk adjustment.
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From page 18... ...
used clinical data. Two studies examined clinical processes, but neither incorporated the processes into their risk adjustment model.
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From page 19... ...
The magnitude of the volume effect on mortality is relatively modest an absolute difference in inpatient mortality of 1% to 2% corresponding to a number needed to treat of 5~100. SUMMARY The 20 studies of cancer surgery suggest that a significant relationship between volume and outcomes does exist.
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From page 20... ...
If the total sample size was 1,000 patients or more, we assigned one point. Because statistical power to detect significant relationships in logistic regression models depends more on the total number of adverse events represented in the sample than on total sample size (and because the various conditions and procedures in this literature have widely varying adverse event rates)
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From page 21... ...
Literature Review Methods We performed two electronic subject-based searches of the literature on MEDLINE (196~1999~. A professional reference librarian assisted us in the development of our search strategy We developed a list of search terms based on subject headings from articles known to be highly relevant to our topic and from the official indexing terms of the MEDLINE database.
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From page 22... ...
We excluded a few studies in which the only dependent variable was a composite of deaths or long lengths of stay, because, formulated in this way, the dependent variable was not purely a health outcome. We also excluded a few studies in which the only dependent variable was a composite of death or complications, with the latter determined solely by secondary diagnosis codes in administrative databases.
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Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. Western Journal of Medicine.
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From page 32... ...
Theriault M, Langer B Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system.
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