Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
JNCI Cancer Spectr. 2022 Mar 2;6(2). doi: 10.1093/jncics/pkac024.
High-volume hospitals have been associated with better outcomes for high-risk cancer surgeries, although concerns exist concerning inequitable access to these high-volume hospitals. We assessed tendencies in access to high-volume hospitals for 4 (lung, pancreatic, rectal, esophageal) high-risk cancer surgeries for Black and Hispanic patients in the National Cancer Database. Hospitals were classified as high volume according to Leapfrog Group volume thresholds. Odds of accessing high-volume hospitals increased over time for Black and Hispanic patients for 3 surgeries, but Black patients had lower probabilities of undergoing a pancreatectomy, proctectomy, or esophagectomy at high-volume hospitals than non-Black patients (eg, 2016 pancreatectomy rate: 49.0% [95% confidence interval (CI) = 45.4% to 52.5%] vs 62.3% [95% CI = 61.1% to 63.5%]). Although for Hispanics the gap narrowed for lung resection and pancreatectomy, these populations continued to have lower probabilities of accessing high-volume hospitals than non-Hispanic patients (eg, 2016 pancreatectomy: 48.8% [95% CI = 44.1% to 53.5%] vs 61.6% [95% CI = 60.5% to 62.8%]). Despite increased access to high-volume hospitals for high-risk cancer surgeries, ongoing efforts to improve equity in access are needed.
高容量医院与高危癌症手术的更好结果相关,但人们对这些高容量医院的公平获取存在担忧。我们评估了国家癌症数据库中 4 种(肺、胰腺、直肠、食管)高危癌症手术中黑人和西班牙裔患者获取高容量医院的趋势。根据 Leapfrog Group 的容量阈值,医院被分类为高容量。对于 3 种手术,黑人和西班牙裔患者获取高容量医院的机会随着时间的推移而增加,但黑人患者在高容量医院接受胰腺切除术、直肠切除术或食管切除术的概率低于非黑人患者(例如,2016 年胰腺切除术率:49.0%[95%置信区间(CI)=45.4%至 52.5%]与 62.3%[95% CI=61.1%至 63.5%])。尽管对于肺切除术和胰腺切除术,西班牙裔的差距缩小了,但这些人群在获取高容量医院方面的机会仍然低于非西班牙裔患者(例如,2016 年胰腺切除术:48.8%[95% CI=44.1%至 53.5%]与 61.6%[95% CI=60.5%至 62.8%])。尽管高危癌症手术获取高容量医院的机会增加,但仍需要努力改善公平获取的机会。