10 September 2012

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Health Report 28 min 2 speakers 8 chapters transcribed 2 days ago

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Why does the hospital where cancer surgery is performed matter more than the individual surgeon?

Norman Swann 0:00

Hello and welcome to the Health Report with me, Norman Swann. Today a twist on the aging population, research which suggests that general practitioners in training aren't seeing enough children with enormous implications for quality of care and access to knowledgeable GPs by parents. The artificial pancreas for people with diabetes, it's getting closer, and a very important story on making decisions about who and where to receive specialist diagnosis and treatment. The risk of dying after certain kinds of cancer surgery can double depending on which hospital you go to for your operation. That's according to a unique study just released by the Cancer Institute New South Wales, and it has enormous implications for how health services are organised across Australia.

Norman Swann 0:43

For many tumors, surgery is the only hope for a cure, so there's a lot riding on which surgeon you're sent to. But in fact choosing your hospital is more important than choosing your surgeon. In people with esophageal and pancreatic cancer, overseas evidence shows up to a quadrupling of postoperative death rates depending on the surgical volume, the numbers of such operations performed at a hospital each year. But local surgeons have questioned that research, so the Kenser Institute, New South Wales, decided to find out what was really happening. Professor David Carrow is the Institute's CEO and the state's chief cancer officer.

David Currow 1:20

We've been measuring for the first time surgical outcomes in New South Wales in a way that hasn't been available to us before. Let's take the example of esophage or cancer. Relatively rare cancer. We perform less than 100 procedures a year with curative intent. And our data shows that we've got more than 25 hospitals doing those procedures. We're seeing variations from teams that do a very small number to those that do a larger number. And some of those variations are pretty important variations for patients. So tell me how you studied this? What we've done for the first time is linked data. We've linked the data from the population cancer registry, the admitted patient data set, which covers Well what range of cancers did you look?

David Currow 2:08

We've looked at a number of cancers, but we started with rare and complex cancers. Esophageal cancer is a relatively rare cancer, but it's one of the most major procedures you can do to another human being and have them come out well at the other end. Pancreas cancer is known for its complications after the operation. The pancreas digests things and it causes a lot of problems in the post operative period. We've also compared that to cancers that are relatively frequently encountered, such as bowel cancer. And importantly in bowel cancer we're not seeing that sort of variation.

Norman Swann 2:42

Did you look at breast cancer?

David Currow 2:43

We've looked at breast cancer but we don't expect to see those sort of problems with breast cancer, because breast cancer doesn't enter a major body cavity, doesn't like bowel or esophageal cancer, have to have us joining pieces of plumbing together. And what outcomes were you looking at? We've looked at length of stay, greater than twenty-one days, readmission to hospital within twenty-eight days. We've looked at thirty day mortality, ninety day mortality, and we've also looked at one year mortality for the people who have survived the first thirty days after the operation. So what have you found? The most important thing is that for high volume cancers like bowel cancer We're not seeing variation across the state.

David Currow 3:23

And so for patients, that means that we know that many patients are driving past two, three, five hospitals, each of which could deliver world's best outcomes.

Norman Swann 3:34

By contrast But just before you go on, that's by institution, that's by hospital. Yes. What about by surgeon? Because there's a a lot of evidence that if you actually have bowel cancer and you go to a general surgeon who doesn't do a lot of them versus a colorectal surgeon who's trained and does nothing but bowel cancer 'cause it can be quite difficult surgery, they do stay less time in hospital and they have less time in intensive care and seem to do better.