title: The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery.
abstract: BACKGROUND
  We conducted a population-based retrospective cohort study to investigate the influence of hospital volume, delay of surgery, and both together on the long-term survival of postoperative cancer patients.
  
  
  METHODS
  Using information from the Korea Central Cancer Registry from 2001 through 2005 and the National Health Insurance claim database, we determined survival for 147 682 patients who underwent definitive surgery for any of six cancers.
  
  
  RESULTS
  Regardless of cancer site, surgical patients in low- to medium-volume hospitals showed significantly worse survival [adjusted hazard ratio (aHR) = 1.36-1.86] than those in high-volume hospitals in multivariable analyses. Among the latter, treatment delays > 1 month were not associated with worse survival for stomach, colon, pancreatic, or lung cancer but were for rectal [aHR = 1.28; 95% confidence interval (CI), 1.17-1.40] and breast (aHR = 1.59; 95% CI, 1.37-1.84) cancer. For patients in low- to medium-volume hospitals, treatment delay was associated with worse survival for all types of cancer (aHR = 1.78-3.81).
  
  
  CONCLUSIONS
  Our findings suggest that the effect of hospital volume and surgical treatment delay on overall survival of cancer patients should be considered in formulating or revising national health policy.
authors.affiliation: Cancer Research Institute, Seoul National University Hospital and College of Medicine, Seoul.
authors.forename: Y H
authors.initials: YH
authors.lastname: Yun
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang; Department of Preventive Medicine, Korea University, Seoul.
authors.forename: Y A
authors.initials: YA
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang.
authors.forename: Y H
authors.initials: YH
authors.lastname: Min
authors.affiliation: The Korea Central Cancer Registry, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang.
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.affiliation: The Korea Central Cancer Registry, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Won
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang.
authors.forename: D Y
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang.
authors.forename: I J
authors.initials: IJ
authors.lastname: Choi
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang.
authors.forename: Y W
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang.
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Health Insurance Review and Assessment Service, Seoul.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Oncology, Asan Medical Center, Seoul.
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Korea University, Seoul.
authors.forename: S J
authors.initials: SJ
authors.lastname: Yoon
authors.affiliation: Department of Surgery, Cancer Research Institute, Seoul.
authors.forename: S Y
authors.initials: SY
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Cancer Research Institute, Seoul. Electronic address: dynoh@snu.ac.kr.
authors.forename: D Y
authors.initials: DY
authors.lastname: Noh
authors.affiliation: Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: D S
authors.initials: DS
authors.lastname: Heo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D015996:Survival Rate; D014850:Waiting Lists; D055815:Young Adult