Grant Number:	2R01CA098481-05A1 Interpret this number
Primary Investigator:	Birkmeyer, John
Organization:	University Of Michigan At Ann Arbor
Project Title:	Structure, Process and Outcomes in Cancer Surgery
Fiscal Year:	2008

DESCRIPTION (provided by applicant): Every year thousands of Americans die or experience serious complications undergoing elective cancer surgery. Wide variations in mortality rates across both hospitals and surgeons suggest that the safety of cancer surgery could be improved substantially, but quality improvement efforts are currently limited by a lack of understanding about mechanisms underlying variations in hospital performance. For example, are high mortality rates at these hospitals attributable to surgical or medical complications? Do high mortality hospitals simply have higher complication rates, or are they instead less proficient at managing complications once they have occurred? Answers to such questions have obvious implications for the types of interventions likely to effect meaningful quality improvement in cancer surgery. Evidence that excess mortality is attributable primarily to surgical site complications would imply the need for interventions aimed at ensuring surgeon proficiency. Variation in specific medical complications would instead suggest the need to focus on processes related to perioperative care. In this context, our project has two specific aims: 1. To determine the causes of excess operative deaths at hospitals with high cancer surgery mortality. Using data from the 2005-6 National Cancer Database, we will identify 20 hospitals with among the lowest cancer surgery mortality rates in the United States (approximately 1.5%) and 30 hospitals with the highest mortality rates (approximately 10%). Based on clinical chart review, we will first compare these two groups of hospitals with regard to cause-specific mortality rates. We will then examine whether differences in cause- specific mortality rates are attributable to differences in the incidence of complications or failure to rescue rates. 2. To identify resources and processes of care that account for differences in complication rates and mortality. With a better understanding of the clinical causes of excess deaths at high mortality hospitals, we will then examine specific structural variables and processes of care that underlie differences in outcomes between the 2 hospital groups. These include factors that may reduce the incidence of complications (e.g.., adherence to evidence-based practices in perioperative care) or improve rescue rates in patients with complications.Project Narrative: Although complication and mortality rates with cancer surgery vary widely across hospitals, efforts aimed improving surgical quality are hindered by a lack of understanding about exactly why some hospitals have better outcomes than others. In this national study of 50 hospitals, we will first determine the clinical causes of excess operative deaths at hospitals with high mortality. We will then identify the resources and processes of care that account for differences in hospital outcomes, with the ultimate goal of identifying best practices and improving care in all settings.




Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery.
Authors: Scally C.P. , Yin H. , Birkmeyer J.D. , Wong S.L. .
Source: Journal Of Surgical Oncology, 2015 Dec; 112(8), p. 866-71.
PMID: 26593455
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Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.
Authors: Grenda T.R. , Revels S.L. , Yin H. , Birkmeyer J.D. , Wong S.L. .
Source: Jama Surgery, 2015 Nov; 150(11), p. 1034-40.
PMID: 26267440
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Variation in hospital mortality rates with inpatient cancer surgery.
Authors: Wong S.L. , Revels S.L. , Yin H. , Stewart A.K. , McVeigh A. , Banerjee M. , Birkmeyer J.D. .
Source: Annals Of Surgery, 2015 Apr; 261(4), p. 632-6.
PMID: 24743604
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Differences in perioperative care at low- and high-mortality hospitals with cancer surgery.
Authors: Revels S.L. , Wong S.L. , Banerjee M. , Yin H. , Birkmeyer J.D. .
Source: Annals Of Surgical Oncology, 2014 Jul; 21(7), p. 2129-35.
PMID: 24710775
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Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue.
Authors: Gonzalez A.A. , Dimick J.B. , Birkmeyer J.D. , Ghaferi A.A. .
Source: Jama Surgery, 2014 Feb; 149(2), p. 119-23.
PMID: 24336902
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Hospital volume and failure to rescue with high-risk surgery.
Authors: Ghaferi A.A. , Birkmeyer J.D. , Dimick J.B. .
Source: Medical Care, 2011 Dec; 49(12), p. 1076-81.
PMID: 22002649
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Racial disparities in the use of revascularization before leg amputation in Medicare patients.
Authors: Holman K.H. , Henke P.K. , Dimick J.B. , Birkmeyer J.D. .
Source: Journal Of Vascular Surgery, 2011 Aug; 54(2), p. 420-6, 426.e1.
PMID: 21571495
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Hospital process compliance and surgical outcomes in medicare beneficiaries.
Authors: Nicholas L.H. , Osborne N.H. , Birkmeyer J.D. , Dimick J.B. .
Source: Archives Of Surgery (chicago, Ill. : 1960), 2010 Oct; 145(10), p. 999-1004.
PMID: 20956770
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Hospital characteristics associated with failure to rescue from complications after pancreatectomy.
Authors: Ghaferi A.A. , Osborne N.H. , Birkmeyer J.D. , Dimick J.B. .
Source: Journal Of The American College Of Surgeons, 2010 Sep; 211(3), p. 325-30.
PMID: 20800188
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Racial differences in treatment and outcomes among patients with early stage bladder cancer.
Authors: Hollenbeck B.K. , Dunn R.L. , Ye Z. , Hollingsworth J.M. , Lee C.T. , Birkmeyer J.D. .
Source: Cancer, 2010-01-01 00:00:00.0; 116(1), p. 50-6.
PMID: 19877112
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Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients.
Authors: Ghaferi A.A. , Birkmeyer J.D. , Dimick J.B. .
Source: Annals Of Surgery, 2009 Dec; 250(6), p. 1029-34.
PMID: 19953723
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Variation in hospital mortality associated with inpatient surgery.
Authors: Ghaferi A.A. , Birkmeyer J.D. , Dimick J.B. .
Source: The New England Journal Of Medicine, 2009-10-01 00:00:00.0; 361(14), p. 1368-75.
PMID: 19797283
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Provider treatment intensity and outcomes for patients with early-stage bladder cancer.
Authors: Hollenbeck B.K. , Ye Z. , Dunn R.L. , Montie J.E. , Birkmeyer J.D. .
Source: Journal Of The National Cancer Institute, 2009-04-15 00:00:00.0; 101(8), p. 571-80.
EPub date: 2009-04-15 00:00:00.0.
PMID: 19351919
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Improving outcomes with lung cancer surgery: selective referral or quality improvement?
Authors: Birkmeyer J.D. .
Source: Annals Of Surgical Oncology, 2009 Jan; 16(1), p. 1-2.
PMID: 18989723
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Hospital lymph node counts and survival after radical cystectomy.
Authors: Hollenbeck B.K. , Ye Z. , Wong S.L. , Montie J.E. , Birkmeyer J.D. .
Source: Cancer, 2008-02-15 00:00:00.0; 112(4), p. 806-12.
PMID: 18085612
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Outcomes after transhiatal and transthoracic esophagectomy for cancer.
Authors: Chang A.C. , Ji H. , Birkmeyer N.J. , Orringer M.B. , Birkmeyer J.D. .
Source: The Annals Of Thoracic Surgery, 2008 Feb; 85(2), p. 424-9.
PMID: 18222237
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Outcomes in octogenarians undergoing high-risk cancer operation: a national study.
Authors: Finlayson E. , Fan Z. , Birkmeyer J.D. .
Source: Journal Of The American College Of Surgeons, 2007 Dec; 205(6), p. 729-34.
PMID: 18035254
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Hospital lymph node examination rates and survival after resection for colon cancer.
Authors: Wong S.L. , Ji H. , Hollenbeck B.K. , Morris A.M. , Baser O. , Birkmeyer J.D. .
Source: Jama : The Journal Of The American Medical Association, 2007-11-14 00:00:00.0; 298(18), p. 2149-54.
PMID: 18000198
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Hospital volume and late survival after cancer surgery.
Authors: Birkmeyer J.D. , Sun Y. , Wong S.L. , Stukel T.A. .
Source: Annals Of Surgery, 2007 May; 245(5), p. 777-83.
PMID: 17457171
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Volume, process of care, and operative mortality for cystectomy for bladder cancer.
Authors: Hollenbeck B.K. , Wei Y. , Birkmeyer J.D. .
Source: Urology, 2007 May; 69(5), p. 871-5.
PMID: 17482924
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Use of adjuvant radiotherapy at hospitals with and without on-site radiation services.
Authors: Wong S.L. , Wei Y. , Birkmeyer J.D. .
Source: Cancer, 2007-02-15 00:00:00.0; 109(4), p. 796-801.
PMID: 17211840
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Racial disparities in late survival after rectal cancer surgery.
Authors: Morris A.M. , Wei Y. , Birkmeyer N.J. , Birkmeyer J.D. .
Source: Journal Of The American College Of Surgeons, 2006 Dec; 203(6), p. 787-94.
PMID: 17116545
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Classifying cause of death after cancer surgery.
Authors: Waljee J.F. , Windisch S. , Finks J.F. , Wong S.L. , Birkmeyer J.D. .
Source: Surgical Innovation, 2006 Dec; 13(4), p. 274-9.
PMID: 17227926
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Volume and process of care in high-risk cancer surgery.
Authors: Birkmeyer J.D. , Sun Y. , Goldfaden A. , Birkmeyer N.J. , Stukel T.A. .
Source: Cancer, 2006-06-01 00:00:00.0; 106(11), p. 2476-81.
PMID: 16634089
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Specialty training and mortality after esophageal cancer resection.
Authors: Dimick J.B. , Goodney P.P. , Orringer M.B. , Birkmeyer J.D. .
Source: The Annals Of Thoracic Surgery, 2005 Jul; 80(1), p. 282-6.
PMID: 15975382
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Do cancer centers designated by the National Cancer Institute have better surgical outcomes?
Authors: Birkmeyer N.J. , Goodney P.P. , Stukel T.A. , Hillner B.E. , Birkmeyer J.D. .
Source: Cancer, 2005-02-01 00:00:00.0; 103(3), p. 435-41.
PMID: 15622523
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Measuring the quality of surgical care: structure, process, or outcomes?
Authors: Birkmeyer J.D. , Dimick J.B. , Birkmeyer N.J. .
Source: Journal Of The American College Of Surgeons, 2004 Apr; 198(4), p. 626-32.
PMID: 15051016
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