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Is Bigger Better? Hospital Size and Survival Rates after Lung Cancer Surgery There has been a long-standing debate over whether a patient receives a better quality of care in smaller hospitals or larger, busier medical facilities. Many patients facing major surgery for conditions such as lung cancer find the concept of a smaller medical facility more comfortable. Along with this comfort level is a belief that treatment may be more personalized and, therefore, more effective. The question remains, however: does the size of a hospital have any correlation to survival rates for individuals undergoing major cancer surgery? A recent study headed by Dr. Peter Bach of the Memorial Sloan-Kettering Cancer Center attempted to identify what relationship, if any, existed between medical centers that performed a high number of lung resections and the survival rate of persons who underwent those procedures. The research tracked 2118 patients and 78 hospitals over an eleven-year period. The hospitals were drawn from a multi-regional collection over 22 states and ranged in size, number of operations performed, and location. The patient database was analyzed for a wide variety of variables that included, but were not limited to, length of survival following surgery, occurrence (or lack thereof) of subsequent complications, and length of stay following surgery. Another significant variable was whether the operation was performed at a teaching hospital or non-teaching hospital. The data on hospitals and patients were then reviewed to determine if, in fact, a relationship existed between patient survival and frequency of procedures performed. The Results Bach and associates found results that appear to fly in the face of some of the popular beliefs about the size of the medical center and the outcome of the procedures performed. First and foremost, the study concluded that the rate of patient survival five years post-surgery was a significant eleven percent higher at those hospitals with the greatest number of lung cancer resections than at centers that had the lowest number of procedures. Additionally, no matter how many operations were performed, teaching hospitals ranked better than non-teaching hospitals in patient longevity. In addition, complications following surgery occurred at a more than 2 to 1 ratio at low volume hospitals as opposed to the busier facilities. Bach's team noted that this could also be a factor in the lower survival rates in those centers where fewer operations took place. The researchers were quick to point out that these results should not bring about an exodus from smaller facilities to larger ones. In fact, such movement of patients could have detrimental results both in larger facilities that could be overburdened by a sudden influx and small facilities that may no longer have sufficient wherewithal to care for those who remain. The results of this study point to facets of cancer care appearing to have a positive impact on patient survival that could be utilized to the benefit of medical institutions large and small. Resource Bach, P., Cramer, L., Schrag, D., Downey, R., Gelfand, S., & Begg, C. (2001, July 19). The influence of hospital volume and survival after resection for lung cancer. [electronic version]. The New England Journal of Medicine, 345(3), 181-188.

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