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Sankaran R, O'Connor J, Nuliyalu U, Diaz A, Nathan H. Payer-Negotiated Price Variation and Relationship to Surgical Outcomes for the Most Common Cancers at NCI-Designated Cancer Centers. Ann Surg Oncol 2024; 31:4339-4348. [PMID: 38506934 DOI: 10.1245/s10434-024-15150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Federal rules mandate that hospitals publish payer-specific negotiated prices for all services. Little is known about variation in payer-negotiated prices for surgical oncology services or their relationship to clinical outcomes. We assessed variation in payer-negotiated prices associated with surgical care for common cancers at National Cancer Institute (NCI)-designated cancer centers and determined the effect of increasing payer-negotiated prices on the odds of morbidity and mortality. MATERIALS AND METHODS A cross-sectional analysis of 63 NCI-designated cancer center websites was employed to assess variation in payer-negotiated prices. A retrospective cohort study of 15,013 Medicare beneficiaries undergoing surgery for colon, pancreas, or lung cancers at an NCI-designated cancer center between 2014 and 2018 was conducted to determine the relationship between payer-negotiated prices and clinical outcomes. The primary outcome was the effect of median payer-negotiated price on odds of a composite outcome of 30 days mortality and serious postoperative complications for each cancer cohort. RESULTS Within-center prices differed by up to 48.8-fold, and between-center prices differed by up to 675-fold after accounting for geographic variation in costs of providing care. Among the 15,013 patients discharged from 20 different NCI-designated cancer centers, the effect of normalized median payer-negotiated price on the composite outcome was clinically negligible, but statistically significantly positive for colon [aOR 1.0094 (95% CI 1.0051-1.0138)], lung [aOR 1.0145 (1.0083-1.0206)], and pancreas [aOR 1.0080 (1.0040-1.0120)] cancer cohorts. CONCLUSIONS Payer-negotiated prices are statistically significantly but not clinically meaningfully related to morbidity and mortality for the surgical treatment of common cancers. Higher payer-negotiated prices are likely due to factors other than clinical quality.
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Affiliation(s)
- Roshun Sankaran
- University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - John O'Connor
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Adrian Diaz
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- IHPI Clinician Scholars Program, Ann Arbor, MI, USA
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Hari Nathan
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA.
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Jawitz OK, Vekstein AM, Young R, Vemulapalli S, Zwischenberger BA, Thibault DP, O'Brien S, Shahian DM, Badhwar V, Thourani VH, Jacobs JP, Smith PK. Comparing Consumer-Directed Hospital Rankings With STS Adult Cardiac Surgery Database Outcomes. Ann Thorac Surg 2023; 115:533-540. [PMID: 35932793 DOI: 10.1016/j.athoracsur.2022.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Public interest in stratifying hospital performance has led to the proliferation of commercial, consumer-oriented hospital rankings. In cardiac surgery, little is known about how these rankings correlate with clinical registry quality ratings. METHODS The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for isolated coronary artery bypass grafting or coronary artery bypass grafting/valve patients at hospitals among the top 100 U.S. News & World Report (USNWR) Cardiology & Heart Surgery rankings from 2016 to 2020. Hospitals were grouped into deciles by risk-adjusted observed/expected (O/E) ratios for morbidity and mortality using the STS 2018 risk models. Agreement between STS Adult Cardiac Surgery Database and USNWR ranked deciles was calculated by Bowker symmetry test. The association between each center's annual change in STS O/E ratio and change in USNWR ranking was modeled in repeated measures regression analysis. RESULTS Inclusion criteria were met by 524 393 patients from 149 hospitals that ranked in USNWR top 100 at least once during the study period. There was no agreement between USNWR ranking and STS major morbidity and mortality O/E ratio (P > .50 for all years). Analysis of patients undergoing surgery at the 65 hospitals that were consistently ranked in the top 100 during the study period demonstrated no association between annual change in hospital ranking and change in O/E ratio (P all > .3). CONCLUSIONS There was no agreement between annual USNWR hospital ranking and corresponding risk-adjusted STS morbidity or mortality. Furthermore, annual changes in USNWR rankings could not be accounted for using clinical outcomes. These findings suggest that factors unrelated to key surgical outcomes may be driving consumer-directed rankings.
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Affiliation(s)
- Oliver K Jawitz
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
| | - Andrew M Vekstein
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Rebecca Young
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Brittany A Zwischenberger
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Dylan P Thibault
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sean O'Brien
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, Georgia
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Peter K Smith
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University, Durham, North Carolina
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Gordon AM, Horn AR, Diamond KB, Ng MK, Magruder ML, Erez O. Which surgeon demographic factors influence postoperative complication rates after total knee arthroplasty at U.S. News and World Report top-ranked orthopedic hospitals? ARTHROPLASTY 2022; 4:24. [PMID: 35781346 PMCID: PMC9252085 DOI: 10.1186/s42836-022-00125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Complication rates are used to evaluate surgical quality-of-care and determine health care reimbursements. The U.S. News & World Report (USNWR) hospital rankings are a highly-referenced source for top hospitals. The objective of this study was to determine the surgeon demographics of those practicing at USNWR Top Ranked Orthopedic Hospitals and if any influence complication rates after total knee arthroplasty (TKA). Methods The 2009–2013 USNWR ‘Orthopedic’ hospital rankings were identified. A database of TKA surgeons with postoperative complication rates was compiled utilizing publicly available data from the Centers for Medicare and Medicaid Services (2009–2013). Using an internet search algorithm, demographic data were collected for each surgeon and consisted of: fellowship training, years in practice, age, gender, practice setting, medical degree type, residency reputation, case volume, and geographic region of hospital. Logistic regression was used to assess the relationship between surgeon demographics and postoperative complication rates. A P value of < 0.008 was considered significant. Results From 2009 to 2013, 660 orthopedic surgeons performed TKA at 80 different USNWR Top-Ranked Hospitals. Mean TKA case volume was 172 (Range, 20–1323) and age of surgeon was 50.8 (Range, 32–77). A total of 372 (56.8%) completed an orthopedic surgery fellowship. Mean adjusted 30-day complication rate was 2.24% (Range, 1.2–4.5%). After adjustment, factors associated with increased complication rates were surgeon age ≤ 42 (OR 3.15; P = 0.007) and lower case volume (≤ 100 cases) (OR 2.52; P < 0.0001). Gender, hospital geographic region, completion of a fellowship, medical degree type, and residency reputation were not significant factors. Discussion Complication rates of total knee arthroplasty surgeons may be utilized by patients and hospitals to gauge quality of care. Certain surgeon factors may influence complication rates of surgeons performing TKA at USNWR Top Ranked Orthopedic Hospitals. Study Type Level III, retrospective observational study.
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Patel DC, Wang H, Bajaj SS, Williams KM, Pickering JM, Heiler JC, Manjunatha K, O'Donnell CT, Sanchez M, Boyd JH, Backhus LM. The Academic Impact of Advanced Clinical Fellowship Training among General Thoracic Surgeons. JOURNAL OF SURGICAL EDUCATION 2022; 79:417-425. [PMID: 34674980 DOI: 10.1016/j.jsurg.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/28/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Advanced clinical fellowship training has become a popular option for surgical trainees seeking to bolster their clinical training and expertise. However, the long-term academic impact of this additional training following a traditional thoracic surgery fellowship is unknown. This study aimed to delineate the impact of an advanced clinical fellowship on subsequent research productivity and advancement in academic career among general thoracic surgeons. METHODS Using an internally constructed database of active, academic general thoracic surgeons who are current faculty at accredited cardiothoracic surgery training programs within the United States, surgeons were dichotomized according to whether an advanced clinical fellowship was completed or not. Academic career metrics measured by research productivity, scholarly impact (H-index), funding by the National Institutes of Health, and academic rank were compared. RESULTS Among 285 general thoracic surgeons, 89 (31.2%) underwent an advanced fellowship, whereas 196 (68.8%) did not complete an advanced fellowship. The most commonly pursued advanced fellowship was minimally invasive thoracic surgery (32.0%). There were no differences between the two groups in terms of gender, international medical training, or postgraduate education. Those who completed an advanced clinical fellowship were less likely to have completed a dedicated research fellowship compared to those who had not completed any additional clinical training (58.4% vs. 74.0%, p = 0.0124). Surgeons completing an advanced clinical fellowship demonstrated similar cumulative first-author publications (p = 0.4572), last-author publications (p = 0.7855), H-index (p = 0.9651), National Institutes of Health funding (p = 0.7540), and years needed to advance to associate professor (p = 0.3410) or full rank professor (p = 0.1545) compared to surgeons who did not complete an advanced fellowship. These findings persisted in sub-analyses controlling for surgeons completing a dedicated research fellowship. CONCLUSIONS Academic general thoracic surgeons completing an advanced clinical fellowship demonstrate similar research output and ascend the academic ladder at a similar pace as those not pursuing additional training.
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Affiliation(s)
- Deven C Patel
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Simar S Bajaj
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Kiah M Williams
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Joshua M Pickering
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Joseph C Heiler
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Keerthi Manjunatha
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Christian T O'Donnell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Mark Sanchez
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Leah M Backhus
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California.
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Mehta R, Tsilimigras DI, Pawlik TM. Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato-pancreatic surgery for cancer. J Surg Oncol 2021; 124:334-342. [PMID: 33961716 DOI: 10.1002/jso.26521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship between hospital Magnet status recognition and postoperative outcomes following complex cancer surgery remains ill-defined. We sought to characterize Textbook Outcome (TO) rates among patients undergoing (HP) surgery for cancer in Magnet versus non-Magnet centers. METHODS Medicare beneficiaries undergoing HP surgery between 2015 and 2017 were identified. The association of postoperative TO (no complications/extended length-of-stay/90-day mortality/90-day readmission) with Magnet designation was examined after adjusting for competing risk factors. RESULTS Among 10,997 patients, 21.3% (n = 2337) patients underwent surgery at Magnet hospitals (non-Magnet centers: 78.7%, n = 8660). On multivariable analysis, patients undergoing HP surgery had comparable odds of achieving a TO at Magnet versus non-Magnet hospitals (hepatectomy: odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.94-1.17; pancreatectomy-OR: 0.88, 95% CI: 0.74-1.06). Patients treated at hospitals with a high nurse-to-bed ratio had higher odds of achieving a TO irrespective of whether they received surgery at Magnet (high vs. low nurse-to-bed ratio; OR: 1.38; 95% CI: 1.01-1.89) or non-Magnet centers (OR: 1.26; 95% CI: 1.10-1.45). Similarly, hospital HP volume was strongly associated with higher odds of TO following HP surgery in both Magnet (Leapfrog compliant vs. noncompliant; OR: 1.24, 95% CI: 1.06-1.44) and non-Magnet centers (OR: 1.18; 95% CI: 1.11-1.26). CONCLUSION Hospital Magnet designation was not an independent factor of superior outcomes after HP surgery. Rather, hospital-level factors such as nurse-to-bed ratio and HP procedural volume drove outcomes.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Tay E, Gambhir S, Stopenski S, Hohmann S, Smith BR, Daly S, Hinojosa MW, Nguyen NT. Outcomes of Complex Gastrointestinal Cancer Resection at US News & World Report Top-Ranked vs Non-Ranked Hospitals. J Am Coll Surg 2021; 233:21-27.e1. [PMID: 33752982 DOI: 10.1016/j.jamcollsurg.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The US News & World Report (USNWR) annual ranking of the best hospitals for gastroenterology and gastrointestinal surgery offers direction to patients and healthcare providers, especially for recommendations on complex medical and surgical gastrointestinal (GI) conditions. The objective of this study was to examine the outcomes of complex GI cancer resections performed at USNWR top-ranked, compared to non-ranked, hospitals. STUDY DESIGN Using the Vizient database, data for patients who underwent esophagectomy, gastrectomy, and pancreatectomy for malignancy between January and December 2018 were reviewed. Perioperative outcomes were analyzed according to USNWR rank status. Primary outcome was in-hospital mortality. Secondary outcomes include length of stay, mortality index (observed-to-expected mortality ratio), rate of serious complication, and cost. Secondary analysis was performed for outcomes of patients who developed serious complications. RESULTS There were 3,054 complex GI cancer resections performed at 42 top-ranked hospitals vs 3,608 resections performed at 198 non-ranked hospitals. The mean annual case volume was 73 cases at top-ranked hospitals compared to 18 cases at non-ranked hospitals. Compared with non-ranked hospitals, top-ranked hospitals had lower in-hospital mortality (0.96% vs 2.26%, respectively, p < 0.001) and lower mortality index (0.71 vs 1.53, respectively). There were no significant differences in length of stay, rate of serious complications, or direct cost between groups. In patients who developed serious morbidity, top-ranked hospitals had a lower mortality compared with non-ranked hospitals (8.2% vs 16.8%, respectively, p < 0.01). CONCLUSIONS Within the context of complex GI cancer resection, USNWR top-ranked hospitals performed a 4-fold higher case volume and were associated with improved outcomes. Patients with complex GI-related malignancies may benefit from seeking surgical care at high-volume regional USNWR top-ranked hospitals.
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Affiliation(s)
- Erika Tay
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Sahil Gambhir
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Stephen Stopenski
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | | | - Brian R Smith
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Shaun Daly
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Marcelo W Hinojosa
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA.
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Hyer JM, Paredes AZ, Tsilimigras DI, Azap R, White S, Ejaz A, Pawlik TM. Preoperative continuity of care and its relationship with cost of hepatopancreatic surgery. Surgery 2020; 168:809-815. [DOI: 10.1016/j.surg.2020.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 01/20/2023]
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Is Hospital Occupancy Rate Associated with Postoperative Outcomes Among Patients Undergoing Hepatopancreatic Surgery? Ann Surg 2020; 276:153-158. [DOI: 10.1097/sla.0000000000004418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mehta R, Tsilimigras DI, Paredes AZ, Dillhoff M, Cloyd JM, Ejaz A, Tsung A, Pawlik TM. Is Patient Satisfaction Dictated by Quality of Care Among Patients Undergoing Complex Surgical Procedures for a Malignant Indication? Ann Surg Oncol 2020; 27:3126-3135. [DOI: 10.1245/s10434-020-08788-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
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Mehta R, Tsilimigras DI, Paredes AZ, Sahara K, Dillhoff M, Cloyd JM, Ejaz A, White S, Pawlik TM. Dedicated Cancer Centers are More Likely to Achieve a Textbook Outcome Following Hepatopancreatic Surgery. Ann Surg Oncol 2020; 27:1889-1897. [PMID: 32108924 DOI: 10.1245/s10434-020-08279-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of the current study is to assess rates of textbook outcome (TO) among Medicare beneficiaries undergoing hepatopancreatic (HP) surgery for cancer at dedicated cancer centers (DCCs) and National Cancer Institute affiliated cancer centers (NCI-CCs) versus non-DCC non-NCI hospitals. PATIENTS AND METHODS Medicare Inpatient Standard Analytic Files were utilized to identify patients undergoing HP surgery between 2013 and 2017. TO was defined as no postoperative surgical complications, no 90-day mortality, no prolonged length of hospital stay, and no 90-day readmission after discharge. RESULTS Among 21,234 Medicare patients, 8.2% patients underwent surgery at DCCs whereas 32.1% underwent surgery at NCI-CCs and 59.7% underwent an operation at neither DCCs nor NCI-CCs. Although DCCs more often cared for patients with severe comorbidities [Charlson score > 5: DCCs, 1195 (68.9%), NCI-CCs, 3687 (54.1%), others, 3970 (31.3%); p < 0.001], DCCs achieved higher rates of TO compared with NCI-CCs and other US hospitals. Interestingly, DCCs were more likely to perform surgery with a minimally invasive approach versus NCI-CCs and other US hospitals (17.0%, n = 295, vs. 12.6%, n = 856 vs. 11.9%, n = 1504, p < 0.001). On multivariable analysis, patients undergoing liver surgery at DCCs had 31% and 36% higher odds of achieving TO compared with NCI-CCs and other US hospitals, respectively. Medicare expenditure was substantially lower for patients achieving TO at DCCs compared with patients who achieved a TO at NCI-CCs. CONCLUSIONS Even though DCCs more frequently took care of patients with high comorbidity burden, the likelihood of achieving TO for HP surgery at DCCs was higher compared with NCI-CCs and other US hospitals. The data suggest that DCCs provide higher-value surgical care for patients with HP malignancies.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan White
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Health Services Management and Policy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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