Hospitals Affiliated With Top-Ranked Cancer Hospitals Have Modest Safety Advantage for Cancer Surgery

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The study found that the advantage was due to factors that affect hospital safety, which were present before affiliation and increased afterward.

Prior to undergoing a surgical procedure for cancer, a patient may have a more favorable perception of a hospital affiliated with a top-ranked cancer hospital. Recent research appearing in JAMA Oncology suggests that this perception is valid, as there is a modest safety advantage at affiliate hospitals for complex cancer surgery.

Researchers searched databases and analyzed unranked affiliate hospitals with unranked hospitals that were not affiliated with a top-ranked cancer hospital. Using the American Hospital Association Data and Insights database, hospital characteristics were collected, while the CMS database was used to collect patient attributes data and 90-day mortality after complex cancer surgery.

“Top-ranked cancer hospitals have increasingly shared their trusted brands with unranked hospitals in the community through hospital affiliations,” the authors explained. “The extent to which affiliation with a top-ranked cancer hospital is associated with cancer surgery outcomes is unknown.”


A total of 2729 patients underwent surgery at nonaffiliate hospitals and 11,464 patients underwent surgery at affiliate hospitals. Following the statistical analysis of the data, the study revealed that 90-day morality after complex cancer surgery was higher at nonaffiliate hospitals compared to those affiliated.

According to the study, these results were due to the hospital characteristics known to affect surgical safety, which mitigated the safety advantage of affiliate hospitals. Before the affiliation took place, the affiliates had more beds, a higher nurse-to-bed ratio, and a higher proportion of them were accredited by the Commission on Cancer.

After affiliation, the hospital characteristics improved even more: 90-day mortality decreased from 9.8% to 6.3% and surgical volume increased from 8.0 to 9.5. Despite this change with affiliation, the data also suggested that mortality in general decreased at all hospitals and the change was not significantly affected by affiliation.

“A favorable mix of hospital characteristics associated with safety at affiliate hospitals appeared to contribute to this mortality advantage (the mortality difference between affiliates and nonaffiliates lost significance after adjustment for these hospital characteristics); thus, affiliate status appears to be a marker but not a robust, independent predictor of favorable outcomes,” the study noted.

Although there was a clear effect of affiliation on the safety and result of cancer surgery, there appears to be a modest safety advantage which may be linked to the selectivity from top-ranked hospitals when choosing which hospitals to affiliate.


Resio BJ, Hoag JR, Chiu AS, Monsalve A, et al. Variations in surgical safety according to affiliation status with a top-ranked cancer hospital [published online July 11, 2019]. JAMA Oncol. doi:10.1001/jamaoncol.2019.1808.