Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Mortality Rates Higher in Affiliate Hospitals

Key clinical point: Affiliate hospital status does not assure the same mortality rates with complex cancer surgery as the top-ranked hospital.

Major finding: Affiliate hospitals have significantly higher mortality rates for complex cancer surgery than top-ranked hospitals.

Study details: A cross-sectional study of 29,228 patients at 59 top-ranked hospitals or 343 affiliated hospitals.

Disclosures: One author reported receiving funding from the Centers for Medicare & Medicaid Services, one reported advisory board and steering committee positions with the private medical sector, and one reported receiving nonfinancial support from private industry outside the submitted work. No other conflicts of interest were reported.


Hoag JR et al. JAMA Netw Open. 2019 Apr 12. doi: 10.1001/jamanetworkopen.2019.1912.


Network affiliations with top-ranked hospitals could help expand access to high-quality cancer care and reduce travel times for patients who live too far away to access the top-ranked hospital itself. However, this study shows that the outcomes and quality of the flagship hospital do not necessarily translate to the affiliate hospitals in the network.

While affiliate hospitals are likely to deal with smaller numbers of complex patients and are less likely to be teaching hospitals, they do offer a way to potentially leverage their affiliation with top-ranked hospitals to improve the overall quality of care for cancer patients. The challenge is to work out how best to do this and to identify which patients are likely to do just as well at an affiliate hospital and which patients will be optimally treated at the flagship hospital.

Lesly A. Dossett, MD, MPH, is from the department of surgery at the University of Michigan, Ann Arbor. These comments are adapted from an accompanying editorial (JAMA Netw Open. 2019 Apr 12. doi:10.1001/jamanetworkopen.2019.1910). No conflicts of interest were reported.