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Association of age with treatment at high-volume hospitals and distance traveled for care, in patients with rectal cancer who seek curative resection

  • Grace C. Lee
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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  • Naomi M. Sell
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
    Search for articles by this author
  • Paul M. Cavallaro
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
    Search for articles by this author
  • Todd D. Francone
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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  • Liliana G. Bordeianou
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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  • Rocco Ricciardi
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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  • Lewis A. Lipsitz
    Affiliations
    Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    The Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA, 02131, USA
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  • Hiroko Kunitake
    Correspondence
    Corresponding author. Division of General and Gastrointestinal Surgery Massachusetts General Hospital 15 Parkman St, WAC-4-460, Boston, MA 02114, USA.
    Affiliations
    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA

    Section of Colon & Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
    Search for articles by this author
Published:September 23, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.09.020

      Highlights

      • Higher facility volume is associated with improved rectal cancer resection outcomes.
      • However, older patients are less likely to be treated at high-volume facilities.
      • This may be partly because older patients tend to travel shorter distances for care.

      Abstract

      Background

      The association between volume and outcomes has led to recommendations that patients undergo surgery at high-volume centers. We aimed to determine if older patients with rectal cancer are undergoing operations at high-volume centers.

      Methods

      We identified patients ≥50 years old who underwent rectal cancer resection using the NCDB (2004–2015). Tertiles were used to categorize facility volume and distance traveled.

      Results

      Higher facility volume was associated with improved outcomes. Patients >75 years old were less likely than patients 50–59 years old to be treated at high-volume centers. Traveling >16.8 miles was associated with treatment at high-volume facilities, however patients >75 years old were less likely to travel >16.8 miles.

      Conclusions

      Higher facility volume is associated with improved outcomes after rectal cancer resection. However, older patients are less likely to be treated at high-volume facilities. Older patients travel shorter distances for care, suggesting that care integration across networks must be optimized.

      Keywords

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