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A VALUE-BASED ANALYSIS OF COLON CANCER SURGERY AT COMMUNITY AND ACADEMIC CENTERS
Edward A. Joseph
*, Muhammad Muntazir Mehdi Khan, Philip E. Schumacher, Brandon Weiss, Casey Allen
Surgical Oncology, Allegheny Health Network, Pittsburgh, PA
Background: Value-based care emphasizes improving outcomes while minimizing costs. There is growing evidence that cancer surgery when performed at specialized centers improves outcomes, while some data suggests performing select procedures at community-based facilities has the potential to save costs. This study evaluates the value of performing a common oncologic procedure at community-based and academic/specialized care facilities.
Methods: Specific ICD-10 diagnosis and procedure codes were used to identify patients who underwent colectomy for malignant neoplasm of the colon from 2021 to 2023, using data from the Vizient® Clinical Data Base. Perioperative outcomes and costs were compared between Peer Group A (PGA) facilities, which include comprehensive academic medical centers, large specialized complex care centers, and the Alliance of Dedicated Cancer Centers, and Peer Group B (PGB) facilities, consisting of complex care medical centers, community hospitals, and critical access/small community hospitals.
Results: Among 22,971 patients, the mean age was 64.6±13.6 years; 47.4% (n=10,892) were female, and 74.2% (n=17,042) were White/Caucasian. Overall, the median length of stay (LOS) was 3.0 (IQR: 2.0-6.0) days, the complication rate was 2.5% (n=578), the 30-day readmission rate was 8.5% (n=1,959), and the in-hospital mortality rate was 0.5% (n=104). Of these patients, 70.2% (n=16,120) received care at PGA facilities. PGA patients were younger (63.8±13.7 vs 66.5±13.4, p<0.001) and more likely to be Black (11.2% vs 10.6%, p=0.010). There were no differences in complication and readmission rates between groups. PGA facilities were associated with lower rates of extended LOS (20.2% vs 22.2%, p<0.001) and in-hospital mortality (0.4% vs 0.6%, p=0.018). The direct costs ($11,565 [$8,524-$15,909] vs $11,290 [$8,366-$16,004], p=0.021) were higher while total costs ($19,535 [$14,541-$26,879] vs $ 19,890 [$14,727-$28,241], p<0.001) were lower in PGA. Multivariable analysis revealed no differences in complications (OR: 1.00, 95% CI: 0.84-1.19, p=0.972), extended LOS (OR: 1.05, 95% CI:0.98-1.13, p=0.174), readmissions (OR: 1.02, 95% CI: 0.93-1.13, p=0.648), and in-hospital mortality (OR: 1.38, 95% CI: 0.93-2.05, p=0.111) between groups. There was no difference in direct costs (OR: 0.99, 95% CI: 0.96-1.01, p=0.183), however, total costs were higher in PGB facilities (OR: 1.03, 95% CI: 1.01-1.05, p=0.010).
Conclusions: There was no difference in perioperative outcomes and costs for colon cancer surgeries performed at community-based and academic/specialized care facilities. These findings establish equipoise in performing common oncologic procedures at both academic and community-based facilities but warrant further investigation into other common cancer surgeries.
Table: Demographic characteristics and peri-operative outcomes of patients undergoing colectomies for colon cancer at peer group A and B facilities.
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