High hospital volume is associated with better outcomes for breast cancer surgery: analysis of 233,247 patients.
BACKGROUND
The relationship between hospital volume and outcomes needs to be further elucidated for low-risk procedures such as surgical therapy of localized breast cancer. The objective of this investigation was to assess the relationship between hospital volume and outcomes for breast cancer surgery.


METHODS
A total of 233,247 patients who underwent breast-conserving therapy (BCT) and breast-ablative therapy (BAT) for localized breast cancer were extracted from 13 years (1988-2000) of the Nationwide Inpatient Samples. Hospital volume was classified as low (<30 cases/year), intermediate (> or =30 to <70 cases/year), and high (> or =70 cases/year). Multiple linear and logistic regression analyses were used to assess the risk-adjusted association between hospital volume and outcomes.


RESULTS
In risk-adjusted analyses, patients operated on at low-volume hospitals were 3.04 (p = 0.03) times more likely to die after BCT compared with patients operated on at high-volume hospitals. Similarly, low-volume hospitals had a significantly higher likelihood of postoperative complications (odds ratio [OR] = 1.73, p = 0.01 for BCT; OR = 1.44, p < 0.001 for BAT) compared with high-volume hospitals. Compared with low-volume hospitals, length of hospital stay was significantly shorter and nonroutine patient discharge significantly lower for high-volume providers for both BCT and BAT (all p < 0.001). Patients were also significantly less likely to undergo BCT if operated on in a low- or intermediate-volume hospital compared with a high-volume provider (p < 0.001).


CONCLUSIONS
High-volume hospitals had significantly lower nonroutine patient discharge, postoperative morbidity and mortality, shorter length of hospital stay, and higher likelihood of performing BCT. Referral of patients with localized breast cancer to high-volume hospitals may be justified.
Department of Surgery, Division of General Surgery, University of Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland. uguller@yahoo.com
Ulrich
U
Guller
Shawn
S
Safford
Ricardo
R
Pietrobon
Michael
M
Heberer
Daniel
D
Oertli
Nitin B
NB
Jain
D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D019992:Databases as Topic; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology