TOPLINE:

Medicare beneficiaries who underwent colon or lung cancer surgery at hospitals that subsequently closed had higher risks for postoperative complications, but most patients had alternative surgical hospitals within 15 minutes of travel time. These findings suggest closures may improve outcomes by directing patients to better-performing facilities.

METHODOLOGY:

• Since 2010, more than 300 hospitals have closed across the US, with an additional 700 at risk for closure in the next decade. Understanding how hospital closures affect cancer surgical care has important implications for access to and outcomes of specialized surgical services.
• Researchers analyzed Medicare administrative data from 2008 to 2019, including 558,708 fee-for-service beneficiaries who had surgery for colon cancer (360,564) or lung cancer (198,144).
• Primary outcomes measured included 90-day mortality, 90-day complications, and length of stay, and secondary outcomes focused on travel measures such as distance to surgical hospital.
• Analysis utilized logistic regression for examining 90-day postoperative mortality and complications, with linear regression for analyzing length of stay.
• Investigators identified closed cancer surgical hospitals as those performing at least one colon or lung cancer surgery and subsequently stopped inpatient care during the study period.

TAKEAWAY:

• Patients who underwent colon cancer surgery at closing vs nonclosing hospitals showed higher odds of 90-day mortality (adjusted odds ratio [aOR], 1.11; 95% CI, 1.01-1.22) and complications (aOR, 1.10; 95% CI, 1.01-1.21).
• Patients who underwent lung cancer surgery at closing vs nonclosing hospitals demonstrated significantly higher odds of 90-day complications (aOR, 1.43; 95% CI, 1.17-1.76), though mortality differences were not statistically significant.
• Beneficiaries treated at closing vs nonclosing hospitals were more often dually eligible — ie, qualifying for both Medicare and Medicaid — (colon, 17.4% vs 10.5%; lung, 12.1% vs 7.4%) and from minority populations (colon, 24.1% vs 15.1%; lung, 20.0% vs 11.2%).
• Most patients treated at their nearest hospital that subsequently closed had access to another surgical facility within 15 minutes driving distance (colon, 79.0%; lung, 90.6%).

IN PRACTICE:

“Our findings suggest that hospital closures may improve postoperative outcomes for cancer surgery, with minimal increase in travel burden, by directing patients to nearby, better-performing hospitals,” the authors of the study wrote.

SOURCE:

The study was led by Min-Young Kim, MPH, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. It was published online on January 13 in JAMA Network Open.

LIMITATIONS:

The study relied on Medicare administrative data, which lacks detailed clinical information such as cancer stage, potentially affecting the assessment of differences in outcomes between hospitals by closure status. Additionally, the analysis was restricted to Medicare fee-for-service patients, limiting generalizability to younger patients or non-fee-for-service populations. The study design cannot establish causality or determine whether the associations reflect valid differences in surgical quality between hospitals or preexisting unmeasured quality issues unrelated to closure.

DISCLOSURES:

The study received support from the National Cancer Institute (RO1CA248470) and the GeoSpatial Resource at the Dartmouth Cancer Center with National Cancer Institute Cancer Center Support Grant P30CA023108-45. Douglas Staiger, PhD, reported receiving grants from the National Institutes of Health during the study and personal fees from ArborMetrix Inc., where he is a founder with equity interest. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.