Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1116–1125 | Cite as

Racial and Socioeconomic Differences in the Use of High-Volume Commission on Cancer-Accredited Hospitals for Cancer Surgery in the United States

  • Nabil Wasif
  • David Etzioni
  • Elizabeth B. Habermann
  • Amit Mathur
  • Barbara A. Pockaj
  • Richard J. Gray
  • Yu-Hui Chang
Health Services Research and Global Oncology



Although major cancer surgery at a high-volume hospital is associated with lower postoperative mortality, the use of such hospitals may not be equally distributed.


Our aim was to study socioeconomic and racial differences in cancer surgery at Commission on Cancer (CoC)-accredited high-volume hospitals.


The National Cancer Database (NCDB) was used to identify patients undergoing surgery for colon, esophageal, liver, and pancreatic cancer from 2003 to 2012. Annual hospital volume for each cancer was categorized using quartiles of patient volume. Patient-level predictors of surgery at a high-volume hospital, trends in the use of a high-volume hospital, and adjusted likelihood of surgery at a high-volume hospital in 2012 versus 2003 were analyzed.


African American patients were less likely to undergo surgery at a high-volume hospital for esophageal (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.49–0.73) and pancreatic cancer (OR 0.83, 95% CI 0.74–0.92), while uninsured patients and those residing in low educational attainment zip codes were less likely to undergo surgery at a high-volume hospital for esophageal, liver, and pancreatic cancer. In 2012, African Americans, uninsured patients, and those from low educational attainment zip codes were no more likely to undergo surgery at a high-volume hospital than in 2003 for any cancer type. These differences were not seen in colon cancer patients, for whom significant regionalization was not seen.


Differences in the use of CoC-accredited high-volume hospitals for major cancer surgery were seen nationwide and persisted over the duration of the study. Strategies to increase referrals and/or access to high-volume hospitals for African American and socioeconomically disadvantaged patients should be explored.



The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the CoC have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.


This study was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.


Nabil Wasif, David Etzioni, Elizabeth B. Habermann, Amit Mathur, Barbara A. Pockaj, Richard J. Gray, and Yu-Hui Chang declare no financial disclosures or conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Nabil Wasif
    • 1
    • 2
  • David Etzioni
    • 2
    • 3
  • Elizabeth B. Habermann
    • 2
  • Amit Mathur
    • 2
    • 4
  • Barbara A. Pockaj
    • 1
  • Richard J. Gray
    • 1
  • Yu-Hui Chang
    • 2
    • 5
  1. 1.Department of Surgery, Division of Surgical OncologyMayo Clinic ArizonaPhoenixUSA
  2. 2.Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes ProgramMayo Clinic ArizonaPhoenixUSA
  3. 3.Department of Surgery, Division of Colorectal SurgeryMayo Clinic ArizonaPhoenixUSA
  4. 4.Department of Surgery, Division of Transplant SurgeryMayo Clinic ArizonaPhoenixUSA
  5. 5.Department of BiostatisticsMayo Clinic ArizonaPhoenixUSA

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