Hospital Performance Rankings Don't Capture Cancer Operation Complexity

Although many US hospitals tout quality improvement in surgical outcomes, new research findings released at the national conference of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), held July 13-16 in San Diego, CA, show that taking cancer operation performance into account would deliver a more accurate hospital rating.

Noting that “oncologic surgical complexity is not adequately captured by the primary procedure code” that’s used to measure hospitals’ surgical quality outcomes, Jennifer L. Paruch, MD, a general surgery resident at the University of Chicago Pritzker School of Medicine and an ACS surgical oncology scholar-in-residence, alongside researchers from the Feinberg School of Medicine at Northwestern University, the University of Wisconsin School of Public Health, and the University of California, Los Angeles, examined whether risk predictions and hospital-quality comparisons would change if cancer status was factored into the calculation.

“Cancer can affect patients in complex ways, and our goal was to determine whether cancer impacts how different hospitals perform for these operations,” Paruch said in a press release.

To do so, the researchers identified hospital patients who underwent colon (n=93,846), rectum (n=13,477), pancreas (n=14,570), liver (n=7,912), esophagus (n=2,226), stomach (n=5,534) or lung (n=3,947) resections — 55 percent of which were performed for cancer indications. Comparing the oncologic and non-oncologic groups, the investigators found that among the cancer patients, the mean ratio of observed complications to expected complications based on patient risk factors and procedure difficulty varied significantly from the mean ratio for non-cancer patients. Of the 309 hospitals treating the patients examined in the study, 127 performed differently depending on cancer status, suggesting that “hospitals that performed well for non-cancer patients may not perform as well for patients with cancer, and vice versa,” the researchers said.

“These results demonstrate that in order to get a true picture of a hospital’s quality performance, quality programs must take into consideration patients who have certain diseases, such as cancer,” Clifford Y. Ko, MD, FACS, director of the ACS Division of Research and Optimal Patient Care, said in the press release. “Hospitals aiming to improve cancer care should look specifically at cancer outcomes — independent from non-cancer procedures — because certain aspects of cancer affect surgical outcomes.” Paruch added that “understanding the factors that contribute to complications is critical to finding ways to prevent complications from occurring.”

As the study authors concluded that “surgical complexity adjustment is feasible and improves risk estimation of 30-day postoperative outcomes for colon, rectal, and pancreatic resections for cancer,” they recommended “collecting robust data specific to cancer patients in order to fully understand complications and what factors impact surgical outcomes, as well as to target quality improvement efforts.”