Bone surgery at lower-volume hospitals does not compromise survival, readmission

Surgical treatment for metastatic disease of bone (MDB) at lower-volume hospitals is not associated with poorer survival or more readmissions, according to a study.

“There may be benefit to referral or consultation with an academic medical centre in some tumour types or clinical scenarios,” the authors said.

This study sought to determine whether patients receiving surgical management of MDB at hospitals with higher volume, medical school affiliation, or Commission on Cancer accreditation have superior outcomes. A total of 9,413 patients surgically treated for extremity MDB between 1992 and 2014 at age ≥66 years were identified using the Surveillance, Epidemiology, and End Results–Medicare database.

The authors used Cox proportional hazard models to calculate the hazards ratios (HRs) for 90-day and 1-year mortality and 30-day readmission according to the characteristics of the hospital where bone surgery was carried out.

No significant difference was observed in 90-day mortality, 1-year mortality, or 30-day readmission associated with hospital volume. After adjusting for demographic and tumour characteristics, an association was seen between major medical school affiliation and lower 90-day (HR, 0.88, 95 percent confidence interval [CI], 0.80‒0.96) and 1-year (HR, 0.92, 95 percent CI, 0.87‒0.99) mortality.

On the other hand, surgical treatment at Commission on Cancer-accredited hospitals significantly correlated with a higher risk of death at 90 days and 1 year after surgery. This association was driven by patients with lung cancer (1-year HR, 1.17, 95 percent CI, 1.07‒1.27).