Department of Surgery, Division of Surgical Oncology, Health Services Management and Policy, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, Division of Colorectal Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Ann Surg Oncol. 2024 Dec;31(13):8517-8529. doi: 10.1245/s10434-024-16217-5. Epub 2024 Sep 14.
US News and World Report (USNWR) hospital rankings influence patient choice of hospital, but their association with surgical outcomes remains ill-defined. We sought to characterize clinical outcomes and costs of surgery for colon cancer among USNWR top ranked and unranked hospitals.
Using Medicare Standard Analytic Files, patients aged ≥65 years undergoing surgery for colon cancer were identified. Hospitals were categorized as 'ranked' or 'unranked' based on USNWR cancer hospital rankings. One-to-one matching was performed between patients treated at ranked and unranked hospitals, and clinical outcomes and costs of surgery were compared.
Among 50 ranked and 2522 unranked hospitals, 13,650 patient pairs were compared. Overall, 30-day mortality was 2.13% in ranked hospitals versus 3.68% in unranked hospitals (p < 0.0001), and the overall paired cost difference was $8159 (p < 0.0001). As patient risk increased, 30-day mortality differences became larger, with the ranked hospitals having 30-day mortality of 7.59% versus 11.84% for unranked hospitals among the highest-risk patients (p < 0.0001). Overall paired cost differences also increased with increasing patient risk, with cost of care being $72,229 for ranked hospitals versus $56,512 for unranked hospitals among the highest-risk patients (difference = $14,394; p = 0.02). The difference in cost per 1% reduction in 30-day mortality was $9009 (95% confidence interval [CI] $6422-$11,597) for lowest-risk patients, which dropped to $3387 (95% CI $2656-$4119) for highest-risk patients (p < 0.0001).
Treatment at USNWR-ranked hospitals, particularly for higher-risk patients, was associated with better outcomes but higher-cost care. The benefit of being treated at highly ranked USNWR hospitals was most pronounced among high-risk patients.
《美国新闻与世界报道》（USNWR）的医院排名会影响患者对医院的选择，但它们与手术结果的关系仍不清楚。我们旨在描述美国 USNWR 顶级排名和未排名医院的结肠癌手术的临床结果和成本。
使用 Medicare Standard Analytic Files，确定年龄≥65 岁接受结肠癌手术的患者。根据 USNWR 癌症医院排名，将医院分为“排名”或“未排名”。对排名医院和未排名医院治疗的患者进行一对一匹配，并比较手术的临床结果和成本。
在 50 家排名医院和 2522 家未排名医院中，比较了 13650 对患者。总体而言，排名医院的 30 天死亡率为 2.13%，而未排名医院为 3.68%（p<0.0001），总体配对成本差异为 8159 美元（p<0.0001）。随着患者风险的增加，30 天死亡率的差异变得更大，风险最高的患者中排名医院的 30 天死亡率为 7.59%，而未排名医院为 11.84%（p<0.0001）。随着患者风险的增加，总体配对成本差异也随之增加，风险最高的患者中排名医院的治疗费用为 72229 美元，而未排名医院为 56512 美元（差异=14394 美元；p=0.02）。30 天死亡率每降低 1%的成本差异为最低风险患者 9009 美元（95%置信区间[CI] 6422-11597），最高风险患者 3387 美元（95%CI 2656-4119）（p<0.0001）。
在 USNWR 排名医院接受治疗，特别是对于风险较高的患者，与更好的结果但成本更高的治疗相关。在高危患者中，接受高排名 USNWR 医院治疗的益处最为明显。
