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Top hospitals have better GI cancer surgery outcomes, lower death rates, UCI study shows

Patients are 2½ times more likely to survive at a ranked, high-volume hospital

March 19, 2021
Dr. Ninh T. Nguyen is a UCI Health gastrointestinal surgeon and chair of the UCI School of Medicine's Department of Surgery.

“Ranking does make sense when you look at surgical case volume and other related issues," said study co-author UCI Health gastrointestinal surgeon Ninh T. Nguyen, MD, FACS. "You really want to go to a hospital where the surgical team performs a lot of these operations.”

A new UCI Health study reinforces the principle that “practice makes perfect” when it comes to complex gastrointestinal cancer surgery.

Patients whose procedures for gastrointestinal malignancies were performed at a hospital ranked as one of America’s “best” by U.S. News & World Report were nearly two-and-a-half times more likely to survive the operation than those who had the same procedure at an unranked hospital, according to the study published March 19 in the Journal of the American College of Surgeons.

“Our study demonstrates that the U.S. News & World Report ranking is a very appropriate resource,” said study co-author Ninh T. Nguyen, MD, a UCI Health gastrointestinal surgeon.

Every year, U.S. News & World Report releases a list ranking the top 50 hospitals for specialty and overall care. These rankings, made available to the public, are based on measures of patient outcomes, patient experience, care-related factors and expert opinion. The annual issue plays a role in guiding patients and providers to high quality healthcare centers. Still, the reliability and accuracy of these rankings for high-risk, complex gastrointestinal surgery was unknown.

“Now that we’ve actually done this analysis, we see the ranking does make sense when you look at surgical case volume and other related issues," said Nguyen, professor and chair of the UCI School of Medicine's Department of Surgery. "Patients who seek surgical care at the top-ranked hospitals actually fare better, at least for treating the complex conditions examined in this study.”

Using data from the Vizient clinical database, the researchers assessed 6,662 patients who underwent elective esophagectomy, gastrectomy, or pancreatectomy for malignancies in 2018 at U.S. academic centers and their affiliated community hospitals.

Of the 6,662 gastrointestinal cancer operations performed, nearly half (3,054) were performed at 42 top-ranked hospitals, compared with 3,608 performed at 198 non-ranked hospitals. The average annual case volume for these high-risk conditions was four times higher at top-ranked hospitals, compared with non-ranked hospitals (72 cases versus 18 cases). Compared with non-ranked hospitals, top-ranked hospitals had a much lower in-hospital death rate.

Specifically, that rate was almost 1% at top ranked hospitals compared with 2.26% at non-ranked hospitals. Top-ranked hospitals also had a lower in-hospital mortality index compared to non-ranked hospitals (0.71 versus 1.53). A score of less than 1 means more patients survived than were expected to, and a score of more than 1 means more patients died than were expected to. For patients who developed serious complications after their operations, top-ranked hospitals also had a much lower in-hospital death rate compared with non-ranked hospitals (8.19% versus 16.79%).

After the researchers factored in patient characteristics such as severity of illness, the death rates were still, on average, lower in the high-volume, ranked hospitals versus non-ranked hospitals.

“Deciding where to go for treatment is a collaborative decision that should be made between the patient and physician. But one of the resources you can use is the annual U.S. News & World Report list,” said Nguyen.

“These are complex operations with a much higher risk of mortality. Therefore, you really want to go to a hospital where the surgical team performs a lot of these operations.”

About UCI Health: UCI Health comprises the clinical enterprise of the University of California, Irvine. Patients can access UCI Health at primary and specialty care offices across Orange County and at its main campus, UCI Medical Center, in Orange, Calif. The 418-bed acute care hospital provides tertiary and quaternary care, ambulatory and specialty medical clinics, and behavioral health and rehabilitation services. UCI Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center and high-risk perinatal/neonatal program, as well as American College of Surgeons-verified Level I adult and Level II pediatric trauma center and regional burn center. It is the primary teaching hospital for the UCI School of Medicine. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow UCI Health on Facebook and Twitter.