Annals of Surgical Oncology

, Volume 26, Issue 12, pp 4083–4090 | Cite as

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

  • Rittal Mehta
  • Aslam Ejaz
  • J. Madison Hyer
  • Diamantis I. Tsilimigras
  • Susan White
  • Katiuscha Merath
  • Kota Sahara
  • Fabio Bagante
  • Anghela Z. Paredes
  • Jordan M. Cloyd
  • Mary Dillhoff
  • Allan Tsung
  • Timothy M. PawlikEmail author
Hepatobiliary Tumors



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.


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.


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.


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).


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.





No sources of funding were used in the preparation of this study.


Rittal Mehta, Aslam Ejaz, J. Madison Hyer, Diamantis I. Tsilimigras, Susan White, Katiuscha Merath, Kota Sahara, Fabio Bagante, Anghela Z. Paredes, Jordan M. Cloyd, Mary Dillhoff, Allan Tsung, and Timothy M. Pawlik have no conflict of interest to declare.

Supplementary material

10434_2019_7677_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)


  1. 1.
    Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis. Colon Rectum. 1995;38(7):705–711.CrossRefGoogle Scholar
  2. 2.
  3. 3.
    Dimick JB, Cowan JA Jr, Knol JA, Upchurch GR Jr. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch. Surg. 2003;138(2):185–191.CrossRefGoogle Scholar
  4. 4.
    Mukherjee S, Kocher HM, Hutchins RR, Bhattacharya S, Abraham AT. Impact of hospital volume on outcomes for pancreaticoduodenectomy: a single UK HPB centre experience. Eur. J. Surg. Oncol. 2009;35(7):734–738.CrossRefGoogle Scholar
  5. 5.
    Gani F, Johnston FM, Nelson-Williams H, et al. Hospital volume and the costs associated with surgery for pancreatic cancer. J. Gastrointest. Surg. 2017;21(9):1411–1419.CrossRefGoogle Scholar
  6. 6.
    Macedo FIB, Jayanthi P, Mowzoon M, Yakoub D, Dudeja V, Merchant N. The impact of surgeon volume on outcomes after pancreaticoduodenectomy: a meta-analysis. J. Gastrointest. Surg. 2017;21(10):1723–1731.CrossRefGoogle Scholar
  7. 7.
    Kanemitsu Y, Komori K, Shida D, et al. Potential impact of lateral lymph node dissection (LLND) for low rectal cancer on prognoses and local control: a comparison of 2 high-volume centers in Japan that employ different policies concerning LLND. Surgery. 2017;162(2):303–314.CrossRefGoogle Scholar
  8. 8.
    Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med. Care. 1994;32(7):700–715.CrossRefGoogle Scholar
  9. 9.
    Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI. Identification of in-hospital complications from claims data. Is it valid? Med. Care. 2000;38(8):785–795.CrossRefGoogle Scholar
  10. 10.
    Weingart SN, Iezzoni LI, Davis RB, et al. Use of administrative data to find substandard care: validation of the complications screening program. Med. Care. 2000;38(8):796–806.CrossRefGoogle Scholar
  11. 11.
    Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504.CrossRefGoogle Scholar
  12. 12.
    Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J. Clin. Epidemiol. 1993;46(10):1075–1079 (discussion 1081–1090).CrossRefGoogle Scholar
  13. 13.
    Pradarelli JC, Healy MA, Osborne NH, Ghaferi AA, Dimick JB, Nathan H. Variation in medicare expenditures for treating perioperative complications: the cost of rescue. JAMA Surg. 2016;151(12):e163340.CrossRefGoogle Scholar
  14. 14.
    Merath K, Chen Q, Bagante F, et al. Variation in the cost-of-rescue among medicare patients with complications following hepatopancreatic surgery. HPB (Oxford). 2019;21(3):310–318.CrossRefGoogle Scholar
  15. 15.
    Martin JT. Compartment syndromes: concepts and perspectives for the anesthesiologist. Anesth. Analg. 1992;75(2):275–283.CrossRefGoogle Scholar
  16. 16.
    Hussey PS, Huckfeldt P, Hirshman S, et al. Hospital and regional variation in Medicare payment for inpatient episodes of care. JAMA Intern. Med. 2015;175(6):1056–1057.CrossRefGoogle Scholar
  17. 17.
    Halliwill JR, Hewitt SA, Joyner MJ, Warner MA. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology. 1998;89(6):1373–1376.CrossRefGoogle Scholar
  18. 18.
    Oliver WC Jr, Abenstein JP, Nuttall GA. Ventilator alarm failure due to modification of the scavenging system. Anesthesiology. 2000;93(5):1351–1352.CrossRefGoogle Scholar
  19. 19.
    Hockings A, Ooi SM, Mwipatayi BP, Sieunarine K. Endovascular graft limb occlusion after an anterior resection for rectal cancer: report of a case. Surg. Today. 2007;37(7):600–603.CrossRefGoogle Scholar
  20. 20.
    Hamilton CA, Robinson WR. Femoral artery occlusion following pelvic cancer surgery. Gynecol. Oncol. 1996;63(1):151–153.CrossRefGoogle Scholar
  21. 21.
    Chase J, Harford F, Pinzur MS, Zussman M. Intraoperative lower extremity compartment pressures in lithotomy-positioned patients. Dis. Colon Rectum. 2000;43(5):678–680.CrossRefGoogle Scholar
  22. 22.
    Sheetz KH, Dimick JB, Ghaferi AA. Impact of hospital characteristics on failure to rescue following major surgery. Ann. Surg. 2016;263(4):692–697.CrossRefGoogle Scholar
  23. 23.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann. Surg. 2009;250(6):1029–1034.CrossRefGoogle Scholar
  24. 24.
    Buettner S, Spolverato G, Amini N, Kim Y, Kilic A, Pawlik TM. The impact of hospital volume and surgeon volume on perioperative outcomes of oncologic liver surgery. J. Am. Coll. Surg. 2015;221(4 Suppl 2):e107.CrossRefGoogle Scholar
  25. 25.
    Mehta HB, Parmar AD, Adhikari D, et al. Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients. J. Surg. Res. 2016;204(2):326–334.CrossRefGoogle Scholar
  26. 26.
    van der Geest LG, van Rijssen LB, Molenaar IQ, et al. Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB (Oxford). 2016;18(4):317–324.CrossRefGoogle Scholar
  27. 27.
    Ejaz A, Sachs T, He J, et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample. Surgery. 2014;156(3):538–547.CrossRefGoogle Scholar
  28. 28.
    McClelland S 3rd, Goldstein JA. Minimally invasive versus open spine surgery: what does the best evidence tell us? J. Neurosci. Rural Pract. 2017;8(2):194–198.CrossRefGoogle Scholar
  29. 29.
    Vora D, Kinnard M, Falk D, et al. A comparison of narcotic usage and length of post-operative hospital stay in open versus minimally invasive lumbar interbody fusion with percutaneous pedicle screws. J. Spine Surg. 2018;4(3):516–521.CrossRefGoogle Scholar
  30. 30.
    Tsilimigras DI, Moris D, Vagios S, Merath K, Pawlik TM. Safety and oncologic outcomes of robotic liver resections: a systematic review. J Surg Oncol. 2018;117(7):1517–1530.CrossRefGoogle Scholar
  31. 31.
    Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch. Surg. 2003;138(11):1198–1206 (discussion 1206).CrossRefGoogle Scholar
  32. 32.
    Paredes AZ, Hyer JM, Beal EW, et al. Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery. Surgery. 2019;166(1):1–7.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Rittal Mehta
    • 1
  • Aslam Ejaz
    • 1
  • J. Madison Hyer
    • 1
  • Diamantis I. Tsilimigras
    • 1
  • Susan White
    • 1
  • Katiuscha Merath
    • 1
  • Kota Sahara
    • 1
  • Fabio Bagante
    • 1
  • Anghela Z. Paredes
    • 1
  • Jordan M. Cloyd
    • 1
  • Mary Dillhoff
    • 1
  • Allan Tsung
    • 1
  • Timothy M. Pawlik
    • 2
    Email author
  1. 1.Department of Surgery, Division of Surgical OncologyThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University, Wexner Medical CenterColumbusUSA

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