For older patients receiving cancer surgery, the risk of dying after complex cancer surgery was considerably lower when surgery was performed at top-ranked cancer hospitals compared with affiliated hospitals that share their brand, according to study results published in JAMA Network Open.

In this cross-sectional study, researchers used data from patients who had non-emergency surgery for colon, lung, pancreatic, stomach, or esophageal cancer from the Centers for Medicare & Medicaid Services 100% Medicare Provider and Analysis Review File and Master Beneficiary Summary File. The list of top-ranked hospitals specializing in cancer care came from U.S. News and World Report, and hospitals that brand-share with these elite cancer hospitals were grouped into the affiliate hospital cohort. The primary outcome was 90-day mortality rate after a complex cancer surgery.

There were 59 top-ranked cancer hospitals and 343 affiliated hospitals included in this study. Affiliate hospitals were generally smaller and less likely to be teaching hospitals. Of the 17,300 patients treated at top-ranked cancer hospitals, 8688 were men, and the mean age was 74.7 years. Of the 11,928 patients treated at affiliate hospitals, 5641 were men and the mean age was 76.2 years. The 90-day mortality rate was higher in the affiliate hospitals when compared with the top-ranked hospitals, with an odds ratio of 1.4 (95% CI, 1.23-1.59; P <.001).

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Independent analysis of each type of cancer surgery revealed that 90-day mortality rate following a colectomy (odds ratio 1.32; P =.001), gastrectomy (odds ratio 2.04; P <.001), and pancreaticoduodenectomy (odds ratio 1.59; P =.009) were significantly higher at the affiliated hospitals when compared with the top-ranked hospitals. For safety, 84.5% of the top-ranked hospitals outperformed their affiliated hospitals.

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Limitations of this study included focusing on patients over the age of 65 years, not incorporating additional clinical and sociodemographic characteristics, and only involving hospitals that brand-share, rather than another type of relationship, with top-ranked hospitals.

The researchers concluded, “Patients who undergo complex cancer surgery at top-ranked cancer hospitals are associated with a considerably lower risk of mortality within 90 days than those having surgery at their affiliate hospitals.”

Disclosure: Anthony W. Kim, MD, reported serving on the advisory board for Medtronic and serving as a member of the Steering Committee for Roche-Genentech. Daniel J. Boffa, MD, reported receiving nonfinancial support from Epic Sciences outside the submitted work.


Hoag JR, Resio BJ, Monsalve AF, et al. Differential safety between top-ranked cancer hospitals and their affiliates for complex cancer surgery. JAMA Netw Open. 2019;2(4):e191912.