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Community hospitals offer a safe surgical option

1st April 2013


Low-risk patients who require certain cancer surgeries can have the procedures performed with low operative mortality rates at community hospitals, according to a new study.

The research showed that for 13 different kinds of cancer surgeries such as gastric and colon, younger patients with few pre-existing illnesses survived operations at community hospitals at a similar rate as at cancer centres.

But patients who are considered high risk or who need complicated cancer surgeries have a higher survival rate at specialised cancer centres. Patients with pancreatic and esophageal cancer, among the most complex cancer surgeries, are twice as likely to survive an operation at a specialised cancer centre. The study defined these centres as those designated as Comprehensive Cancer Centers by the National Cancer Institute and those that have the highest volume of specific cancer surgeries.

The study from Northwestern's Feinberg School of Medicine and the American College of Surgeons will be published in a future issue of the Annals of Surgery and is accessible via its Web site. The study measured the death rates (known as perioperative mortality) after surgery.

Lead author Karl Bilimoria, M.D., surgery resident at the Feinberg School and a research fellow at the American College of Surgeons, noted that the study does not look at long-term survival after surgery or factors that affect long-term outcomes, such as whether surgery removed all of the cancer.

"There may be other reasons patients should be referred to specialised cancer centres beyond perioperative mortality," he said. Those reasons may include access to clinical trials and treatment options only available in an academic setting, state of the art technology and health professionals who specialise in a specific kind of cancer.

"Our findings provide new evidence about which patients need to be referred to a cancer centre and which ones can have surgery in their own backyards," said Bilimoria. "This may make treatment more convenient for many patients. Sometimes it's prohibitively expensive for someone to travel to get care at a high-volume centre. Patients also like to stay with their original doctors and close to their family."

The study used data from the National Cancer Data Base and looked at 940,718 patients from 1,430 hospitals. It was supported by a grant from Northwestern University and the American College of Surgeons' Clinical Scholars in Residence Program.





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