The 90-day mortality for several complex cancer surgeries was higher among affiliated hospitals compared with their flagship cancer hospital location, a cross-sectional study found. The results were published April 12, 2019, in JAMA Network Open.1

Lesly A. Dossett, MD, MPH, department of surgery, University of Michigan, Ann Arbor, wrote in a corresponding commentary that the study “adds to the growing body of literature on cancer hospital networks and draws attention to the need for networks not to simply brand share but to actively work to achieve optimal integration.”2

To investigate surgical mortality differences, the study authors reviewed the Centers for Medicare and Medicaid Services 100% Medicare Provider and Analysis Review file for 59 top-ranked, flagship cancer hospitals and 343 affiliated hospitals. In all, 17,300 Medicare beneficiaries had complex cancer surgery at a flagship cancer hospital and 11,928 Medicare beneficiaries had complex cancer surgery at an affiliated hospital. Procedures received were lobectomy, esophagectomy, gastrectomy, colectomy, and pancreaticoduodenectomy, and all were completed between January 1, 2013, and October 1, 2016.

Continue Reading

Related Articles

Patients who underwent complex cancer surgery at an affiliated hospital had a significantly higher likelihood of death within 90 days (odds ratio [OR], 1.40; 95% CI, 1.23-1.59; P <.001). The likelihood of death within 90 days was the lowest for colectomy (OR=1.32; 95% CI, 1.12-1.56; P=.001) and the highest for gastrectomy (OR, 2.04; 95% CI, 1.41-2.95; P <.001). Esophagectomy was the only procedure for which the 90-day mortality was increased but not statistically significant (OR, 1.48; 0.98-2.22; P =.06).

Standardized mortality ratios (SMRs) calculated for each flagship hospital and their affiliates revealed lower SMRs for the majority of flagship hospitals (84.3%)* compared with their affiliates, suggesting flagship hospitals may be safer.

“The likelihood of surviving complex cancer surgery appears to be greater at top-ranked cancer hospitals compared with the affiliated hospitals that share their brand,” wrote the study authors in conclusion. “Further investigation of performance across trusted cancer networks could enhance informed decision making for complex cancer care.”

*Update: This number was changed from 83.7% to 84.3% on September 16, 2019, to reflect the following acknowledgement by JAMA Network Open that there was a data error in the results section. Their corrected sentence is: “When the safety of each top-ranked hospital was compared with each of its affiliates, the top-ranked hospitals outperformed 84.3% of their affiliates (289 of 343).”


  1. Hoag JR, Resio BJ, Monsalve AF, et al. Differential safety between top-ranked cancer hospitals and their affiliates for complex cancer surgery. JAMA Netw Open. 2019;2(4):e191912.
  2. Dossett LA. Cancer hospital network affiliation and complex cancer surgery—What is in a name? JAMA Netw Open. 2019;2(4):e191910.