Impact of hospital volume on people with disability and outcomes for cancer surgery

Abstract

Background: This study was performed to examine the association between hospital volume and mortality in people with disability.

Methods: A retrospective cohort study was conducted using a data set linking the Korean National Health Service database, disability registration data, and Korean Central Cancer Registry data. Data was gathered from all patients undergoing the four major surgical procedures for cancer care during an 11-year period from 2003 to 2013.

Results: For all procedures, patients with disability were more likely to visit low-volume hospitals compared with those without disability. The 30-day mortality rate after each type of surgery at low-surgery-volume hospitals was higher in patients with disability; especially, the mortality rates after colectomy were 1.1% for patients without disabilities and 2.6% for patients severely disabilities. In univariate logistic regression analyses, patients with disability, especially those with severe or intellectual/psychological disabilities, were significantly less likely to undergo treatment at a high-volume hospital compared with patients without disability. In contrast, multiple logistic regression analysis indicated that patients with disability were significantly more likely to undergo gastrectomy (OR 3.76, 95% CI 1.64-8.58), colectomy (OR 3.08, 95% CI 1.46-6.48), and mastectomy (OR 3.92, 95% CI 1.25-12.33) at a high-volume hospital compared with patients without disability.

Conclusion: Public health policies should focus on patients with disability to reduce health disparities and educate health care professionals, as well as the patients and their families, to alleviate negative perceptions about the need for equal diagnosis and treatment.