Selecting the highest-performing local hospital for colorectal cancer surgery was associated with a $1953 gain in social welfare per patient and a 0.24% absolute reduction in mortality risk.
Observational (n=21,098)
Yes
Does selecting the highest-performing local hospital improve social welfare and reduce mortality in patients undergoing elective colorectal resection?
Data-driven selection of the highest-performing local hospital for colorectal cancer surgery is associated with reduced mortality and improved social welfare.
Mean Difference: 1953 (95% CI 1744–2162)
Absolute Risk Reduction: 0.24%
Importance: Variation in outcomes across hospitals adversely affects surgical patients. The use of high-quality hospitals varies by population, which may contribute to surgical disparities. Objective: To simulate the implications of data-driven hospital selection for social welfare among patients who underwent colorectal cancer surgery. Design, Setting, and Participants: This economic evaluation used the hospital inpatient file from the Florida Agency for Health Care Administration. Surgical outcomes of patients who were treated between January 1, 2016, and December 31, 2018 (training cohort), were used to estimate hospital performance. Costs and benefits of care at alternative hospitals were assessed in patients who were treated between January 1, 2019, and December 31, 2019 (testing cohort). The cohorts comprised patients 18 years or older who underwent elective colorectal resection for benign or malignant neoplasms. Data were analyzed from March to October 2022. Exposures: Using hierarchical logistic regression, we estimated the implications of hospital selection for in-hospital mortality risk in patients in the training cohort. These estimates were applied to patients in the testing cohort using bayesian simulations to compare outcomes at each patient's highest-performing and chosen local hospitals. Analyses were stratified by race and ethnicity to evaluate the potential implications for equity. Main Outcomes and Measures: The primary outcome was the mean patient-level change in social welfare, a composite measure balancing the value of reduced mortality with associated costs of care at higher-performing hospitals. Results: A total of 21 098 patients (mean SD age, 67. 3 12. 0 years; 10 782 males 51. 1%; 2232 Black 10. 6% and 18 866 White 89. 4% individuals) who were treated at 178 hospitals were included. A higher-quality local hospital was identified for 3057 of 5000 patients (61. 1%) in the testing cohort. Selecting the highest-performing hospital was associated with a 26. 5% (95% CI, 24. 5%-29. 0%) relative reduction and 0. 24% (95% CI, 0. 23%-0. 25%) absolute reduction in mortality risk. A mean amount of 1953 (95% CI, 1744-2162) was gained in social welfare per patient treated. Simulated reassignment to a higher-quality local hospital was associated with a 23. 5% (95% CI, 19. 3%-32. 9%) relative reduction and 0. 26% (95% CI, 0. 21%-0. 30%) absolute reduction in mortality risk for Black patients, with 2427 (95% CI, 1697-3158) gained in social welfare. Conclusions and Relevance: In this economic evaluation, using procedure-specific hospital performance as the primary factor in the selection of a local hospital for colorectal cancer surgery was associated with improved outcomes for both patients and society. Surgical outcomes data can be used to transform care and guide policy in colorectal cancer.
Finn et al. (Wed,) conducted a observational in Colorectal cancer (n=21,098). Data-driven hospital selection vs. Chosen local hospitals was evaluated on Mean patient-level change in social welfare (MD 1953, 95% CI 1744-2162). Selecting the highest-performing local hospital for colorectal cancer surgery was associated with a $1953 gain in social welfare per patient and a 0.24% absolute reduction in mortality risk.