A new study by Yale Cancer Center (YCC) researchers shows complex cancer surgery is safer at brand name cancer hospitals than at affiliated hospitals that share the top-notch brand names. The findings were reported today in the Journal of the American Medical Association (JAMA) Network Open.
Examining outcomes from almost 30,000 Medicare patients treated at more than 400 hospitals, the researchers found patients undergoing major cancer surgery at main hospital locations were considerably less likely to die within 90 days of the operation than those having surgery at the hospitals within an affiliated network location. The data shows that on average, the risk of dying after cancer surgery of the lung, colon, pancreas, stomach or esophagus is 1.4 times higher at affiliate hospitals, as compared to the main hospital whose brand they share.
“These findings will likely come as a surprise to the significant proportion of the public that believes that all hospitals that carry the brand name of a well-known and respected center will offer equivalent care,” said the study’s senior author, Daniel J. Boffa, M.D., professor of surgery at Yale School of Medicine and an investigator at Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER). “Over the past several years, leading cancer hospitals have increasingly shared their brands with smaller hospitals through marketing affiliations. Such alliances may represent concerted efforts to align and improve safety and quality of care—but this isn’t always the case.” In this study, the median number of affiliates for each brand name hospital was four, and six hospitals had no affiliates. In general, affiliate hospitals were smaller (210 beds vs. 711) and less likely to be teaching hospitals (11% vs. 95%) compared to the brand name hospitals.
Federal outcomes data was examined for 29,228 Medicare patients who received one of five difficult cancer surgeries: lobectomy (removal of a lung lobe), colectomy (removal of part of the large intestine), gastrectomy (stomach surgery), esophagectomy (removal of part or all of the esophagus), or Whipple (pancreatic surgery). Of this group, 17,300 (59%) patients had surgery at brand name hospitals and 11,928 (41%) at affiliates.
The study could not determine the safety differential between each affiliate hospital and the hospital whose brand they share – however the researchers found that brand name hospitals outperformed their collective affiliates 85% of the time. “That is not to say that the affiliated hospitals are unsafe,” explained Boffa. “In fact, 34% of affiliate hospitals performed better than the national average. Our findings simply suggest that complex cancer surgery is in general, considerably safer at the brand name hospitals.”
“The current study was not designed to explain why affiliate hospitals are less safe,” said Boffa, “But reasonable explanations could include the fact that affiliates do not perform a high volume of risky cancer surgeries and that they are not teaching hospitals that have layers of expert staffing and nursing,” he added.
Boffa and his colleagues see a silver lining behind the findings. “One of the biggest challenges to improving surgical safety has been finding a way to share what works well at the country’s safest hospitals,” said Boffa. “The recognition that so many hospitals with room to improve are already connected to the safest hospitals is a huge advance. Now we just need to figure out the best way to leverage these connections.”
Other study co-authors from Yale are Jessica R. Hoag, Ph.D., Benjamin Resio, M.D., Andres F. Monsalve, M.D., Alexander S. Chin, M.D, M.P.H., Lawrence Brown, M.P.H., Jeph Herrin, Ph.D., and Justin D. Blasberg, M.D.
The study was funded by contributions from patients from the Division of Thoracic Surgery at Yale School of Medicine.