Hospital volume, surgeon volume, and patient costs for cancer surgery

BACKGROUND: Several cancer surgery studies document an association between higher provider volume and lower mortality rates. Less is known about the relative influence of hospital and surgeon volume on patient costs. We evaluate associations between hospital and surgeon volume and inpatient costs for 6 cancer resections. METHODS: We analyzed administrative discharge data on patients receiving 1 of 6 cancer resections in Florida, New Jersey, and New York between 1989 and 2000. After dividing hospital and surgeon volumes into tertiles, we examined the relations between the total cost of an inpatient stay and surgeon and hospital volume, adjusting for patient and hospital characteristics. We tested for differences in adjusted volume-cost relationships that persisted throughout the sample period, versus those that lasted for shorter periods. RESULTS: For the entire sample period, relative to low-volume surgeons, high-volume surgeons were 5.5% less costly for pneumonectomy (P = 0.005) and 10.6% less costly for esophagectomy (P < 0.001). For the 4 other procedures, high-volume surgeons were less costly than low-volume surgeons for the periods 1993-1996 and 1997-2000 (all P values < 0.001). The lowest differential was for colectomy (4.4% in 1993-1996, P < 0.001), and the highest differential was for pancreaticoduodenectomy (25.6% in 1993-1996, P < 0.001). High hospital volume was associated with lower costs only for colectomy (P = 0.02). CONCLUSIONS: High surgeon volume, rather than high hospital volume is associated with lower inpatient cancer surgery costs, and the relationship has become significant in recent years for each cancer procedures examined. These data suggest that cost savings are best achieved through a surgeon-specific referral program.