Effect of hospital systems on surgical outcomes in cancer patients.

Abstract

e16449 Background: Individual hospitals are rapidly consolidating into large healthcare systems. While evidence exists on volume-outcome relationships for individual hospitals for the Whipple procedure, evidence on healthcare systems is lacking. We aim to compare outcomes for patients undergoing Whipple procedures between flagship and non-flagship hospitals to examine how hospital systems impact surgical quality for highly specialized surgical care. Methods: Utilizing New York State’s (NYS) Statewide Planning and Research Cooperative System, we identified adult patients who underwent Whipple’s procedure between 2016 and 2019. Patients were categorized into two cohorts: those treated in a flagship (highest volume hospital in a system) or non-flagship hospital. Free-standing hospitals and systems with fewer than 5 Whipple procedures annually at their flagship hospital were excluded (n = x). Patients with a non-pancreatic cancer that metastasized to the pancreases and patients with concomitant surgeries performed same-day were excluded (n = x). 1:1 propensity score matching was performed to balance cohorts for analysis. Patient characteristics and outcomes (30-day and 90-day) were analyzed between cohorts in unmatched and matched (on sex, race and insurance) samples using bivariate and multivariate analysis with alpha set at 0.05. Results: Overall, 1633 patients were included: 1126 (68.6%) received care at flagship hospitals and 515 (31.4%) at non-flagship hospitals. Whipple procedures were performed in X% of NYS hospitals including Y systems (Median hospitals per system: X). Patients treated at flagship hospitals were more often White (65% vs. 41%, p < 0.01) and less often Medicaid recipients (17% vs 30%, p < 0.01) versus non-flagship hospitals. After propensity-score-matching, patients at flagship hospitals had lower 30-day transfusion requirements (18% vs. 27%, p < 0.01), and overall fewer postoperative complications at 30-days (47% ) and 90-days (49% vs. 56%, p = 0.03) compared to patients in non-flagship hospitals in the same system; there was no difference in 90-day readmission (18% vs. 17%, p = 0.49) or mortality (2% vs 1%, p = 0.23). Conclusions: When planning a Whipple procedure, patients should be referred to the highest volume Whipple procedure hospital within their healthcare system to optimize post-operative outcomes. To facilitate access to high quality surgical services, providers should screen patients for social determinants or health and help connect patients with appropriate services to minimize patients burden and financial toxicities.