title: Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care.
abstract: Our objective was to determine the hospital resources required for low-volume, high-quality care at high-volume cancer resection centers.
  
  
  
  Patients who underwent esophageal, pancreatic, and rectal resection for malignancy were identified using Healthcare Cost and Utilization Project State Inpatient Database (Florida and California) between 2007 and 2011. Annual case volume by procedure was used to identify high- and low-volume centers. Hospital data were obtained from the American Hospital Association Annual Survey Database. Procedure risk-adjusted mortality was calculated for each hospital using multilevel, mixed-effects models.
  
  
  
  A total of 24,784 patients from 302 hospitals met the inclusion criteria. Of these, 13 hospitals were classified as having a high-volume, oncologic resection ecosystem by being a high-volume hospital for ≥2 studied procedures. A total of 11 of 31 studied hospital factors were strongly associated with hospitals that performed a high volume of cancer resections and were used to develop the High Volume Ecosystem for Oncologic Resections (HIVE-OR) score. At low-volume centers, increasing HIVE-OR score resulted in decreased mortality for rectal cancer resection (P = .038). HIVE-OR was not related to risk-adjusted mortality for esophagectomy (P = .421) or pancreatectomy (P = .413) at low-volume centers.
  
  
  
  Our study found that in some settings, low-volume, high-quality cancer surgical care can be explained by having a high-volume ecosystem.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.
authors.forename: Anai N
authors.initials: AN
authors.lastname: Kothari
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Blanco
authors.affiliation: One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Brownlee
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Evans
authors.affiliation: One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Chang
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Abood
authors.affiliation: School of Computing, DePaul University, Chicago, IL.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Settimi
authors.affiliation: School of Computing, DePaul University, Chicago, IL.
authors.forename: Daniela S
authors.initials: DS
authors.lastname: Raicu
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL. Electronic address: paul.kuo@luhs.org.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods / Q000401:mortality*; D016208:Databases, Factual; D017753:Ecosystem; D016629:Esophagectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000379:methods / Q000401:mortality*; D011787:Quality of Health Care; D012380:Role; D016019:Survival Analysis; D014481:United States