Breast cancer surgery: do all patients want to go to high-volume hospitals?
BACKGROUND
Inequalities in access to high-volume hospitals have been found for many surgical procedures. We aimed to assess the association between patients' choice and the volume of the hospital where they underwent breast cancer surgery.


METHODS
Multivariate analysis of data from 932 women who underwent breast cancer surgery in low-, moderate- or high-volume hospitals in France.


RESULTS
One hundred fifty-six (17%) patients underwent an operation in low-volume, 414 (44%) in moderate-volume, and 362 (39%) in high-volume hospitals. Patients in low-volume hospitals were more likely to be >70 years old (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-3.4), and to have an elementary education level (adjusted OR, 7.1; 95% CI, 2.4-21.2). In areas where there was a low number of surgical beds per 1000 population, patients were more likely to go to low-volume hospitals, with no difference between patients involved (adjusted OR, 10.1; 95% CI, 3.3-31.0) and not involved (adjusted OR, 11.6; 95% CI, 2.9-46.0) in surgeon choice. In areas where there was a higher number of surgical beds per 1000 population, patients who were involved in surgeon choice were more likely to go to low-volume hospitals (adjusted OR, 4.4; 95% CI, 1.5-13.1).


CONCLUSIONS
Some patients who were involved in surgeon choice opted to go to a low-volume hospital, nearer to their place of residence. Even though a minimum threshold of activity has been established in France for breast cancer surgery, volume-based referral policies should anticipate their potentially negative consequences of going against the will of older and more isolated patients.
Pôle Pharmacie et Santé Publique, CHU de Poitiers, Université de Poitiers, Poitiers, France.
Gauthier
G
Bouche
Virginie
V
Migeot
Simone
S
Mathoulin-Pélissier
Roger
R
Salamon
Pierre
P
Ingrand
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D002755:Choice Behavior; D015331:Cohort Studies; D005260:Female; D005602:France; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012017:Referral and Consultation