Original CommunicationCancer care in the pediatric surgical patient: A paradigm to abolish volume-outcome disparities in surgery
Section snippets
Methods
Florida is the fourth most populous state in the country. Since 1981, the Florida Cancer Data System (FCDS) has collected information on all cancer cases in the state of Florida, which comprises approximately 6% of the U.S. population. This cancer registry currently includes over 2.7 million records. In 1994, the FCDS became part of the National Program of Cancer Registries (NPCR), which is administered by the Centers for Disease Control and Prevention (CDC). Over 96,000 reportable invasive
Hospital volume
From 1981 to 2004, a total of 66 and 55 centers in Florida treated at least 1 patient 18 years of age or younger with the diagnosis of NBL or WT, respectively (Table I). Of the 869 patients with NBL identified, 463 were treated at 5 HVC and 406 were treated at 61 LVC using the previously described case-volume stratification (Fig 1). Similarly, for the 790 patients with WT identified, 395 were treated at 5 HVC and 395 were treated at 50 LVC.
Patient demographics and clinical data
During the 24-year study period, there were a total of
Discussion
There is a plethora of reports in the medical literature supporting a direct correlation between procedural volume and treatment outcome. A systematic review and critique of the literature published by Halm et al24 in 2002 revealed 135 studies. More than 70% of studies examining hospital volume reported a statistically significant association between greater volume and improved outcomes. Many of these reports focus on cancer-related procedures, but the effect of volume on mortality has also
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2019, European Journal of CancerCitation Excerpt :The risk was lower and became non-significant after adjustment for stage, extent of resection, meningitis and sex, suggesting that the cases treated in minor hospitals were complicated or more advanced [6]. Only two studies considered in the Knops review, on the effect of hospital volume in CC outcome [1], included a complete collection of stage [6,7]. They found a slightly more advanced stage at diagnosis for medulloblastoma and Wilms tumours in low-volume hospitals than high-volume hospitals.
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2018, Journal of Surgical ResearchThe association between nephroblastoma-specific outcomes and high versus low volume treatment centers
2017, Journal of Pediatric SurgeryCitation Excerpt :One aspect of the heterogeneity between studies is the definition of high and low volume. A variety of methods have been used including, as we did, dividing at the median number of patients and considering those in the upper median as high volume and the lower median as low volume [7,10]. Additional methods include dividing into tertiles, quartiles or case minimums [3,6,8,10,33].
Supported in part by the James and Ester King Tobacco Research Grant.