Mortality rates for complex cancer procedures differ greatly between one-star hospitals (10.4%) and five-star hospitals (6.4%), according to researchers from Yale School of Medicine. The safety of complex cancer surgeries varies widely across hospitals in the United States, with as much as a four-fold difference in hospital mortality rates, volume of patients, hospital experience, and surgeon training. Researchers have previously suggested that a large-scale shift of patients away from high-risk hospitals could meaningfully reduce mortality rates for complex cancer surgeries. Yet there are numerous challenges to matching patients with hospitals that are best suited to perform a specific procedure. In particular, hospital volumes and surgery-specific performance data are not readily available to patients and providers.
In the study, researchers examined the Center for Medicare and Medicaid Services' ‘Star Rating’ system, which serves as a guide for patients to compare the quality of each hospital's care (one-star = lowest to five-star= highest). This system is based on 62 measurements (e.g. mortality, readmissions, patient experience), but is not specific to any medical operation or patient population. Despite this fact, researchers found that the ratings correlate with quality and safety across many patient care scenarios, including the risk of mortality after complex cancer surgery.
A total of 105,823 patients underwent complex cancer procedures at 3,146 hospitals between 2013 and 2016. Eligible patients were over 65 years old with a diagnosis of cancer of the lung, colon, stomach, oesophagus or pancreas. This group captures an estimated 80% of all high-risk cancer surgeries.
The mortality rating over a 90-day period correlated with the star system, with the greatest difference observed between the 1-star (10.4%) and 5-star (6.4%) hospitals. However, these rates varied by surgery type.
Reassignment of patients from 1-star to 5-star hospitals (7.8% of patients) was predicted to save 84 Medicare beneficiaries each year. This impact varied by procedure (colectomy: 47 lives/year to gastrectomy: 5 lives/year). Overall, 2,189 patients would have to change hospitals each year to improve outcomes (26 patients moved to save one life).
These findings are consistent with prior studies that have found that the Center for Medicare and Medicaid Services' star rating system correlates with surgical mortality. And yet, the overall effectiveness of this system in choosing hospitals for complex cancer surgeries appears to be modest (84 lives per year), relative to other proposed strategies.
"For complex cancer care, choosing the right hospital may be as important as choosing the right treatment.," said lead author, Dr Daniel Boffa from Yale School of Medicine. "In order for patients to select the best hospital for their situation, they need access to understandable information regarding the safety and quality of hospital care. Unfortunately, the CMS star-rating system, while clear and easy to access, does not appear to distinguish the safest from the least safe hospitals with enough separation to reliably guide cancer patient choice for complex surgical care."
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