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The Impact of Dedicated Cancer Centers on Outcomes Among Medicare Beneficiaries Undergoing Liver and Pancreatic Cancer Surgery

Rittal Mehta MPH, BDS, Aslam Ejaz MD, J. Madison Hyer MS, Diamantis I. Tsilimigras MD, Susan White PhD, Katiuscha Merath MD, Kota Sahara MD, Fabio Bagante MD, Anghela Z. Paredes MD, Jordan M. Cloyd MD, Mary Dillhoff MD, Allan Tsung MD, Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)
Hepatobiliary Tumors
Volume 26, Issue 12 / November , 2019

Abstract

Background

The Alliance of Dedicated Cancer Centers (DCCs) is comprised of 11 institutions that are exempt from the prospective payment system utilized by Medicare for hospital reimbursement.

Objective

The aim of this study was to compare short- and long-term outcomes of patients undergoing liver and pancreatic surgery for cancer at DCCs versus non-DCCs.

Methods

Patients who underwent a liver or pancreatic operation for a malignant indication between 2013 and 2015 were identified using the Medicare Inpatient Standard Analytic Files. Regression analyses and the Kaplan–Meier method were used to assess short- and long-term outcomes of patients at DCCs versus non-DCCs.

Results

Among 13,256 patients, 7.0% of patients were treated at a DCC. Median patient age and complexity of surgical procedures were comparable among DCCs and non-DCCs (all p > 0.05). Overall complications (16.5% vs. 23.6%), 90-day readmission (26.2% vs. 30.2%), and 90-day mortality (3.0% vs. 8.7%) were lower at DCCs compared with non-DCCs (all p < 0.001). In addition, long-term hazards of death among patients undergoing hepatectomy [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.54–0.75] and pancreatectomy (HR 0.66, 95% CI 0.56–0.78) were lower among patients treated at DCCs (both p <  0.05). While Medicare payments for patients undergoing pancreatic surgery (DCC: $22,200 vs. non-DCC: $22,100; p = 0.772) were comparable among DCC and non-DCC hospitals, Medicare payments for liver resection at DCCs were 13.9% lower than non-DCCs (DCC: $16,700 vs. non-DCC: $19,400; p < 0.001).

Conclusions

Patients undergoing hepatopancreatic surgery at DCCs had better short- and long-term outcomes for the same/lower level of Medicare expenditure as non-DCC hospitals. DCCs provide higher-value surgical care for patients undergoing liver and pancreatic cancer operations.

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