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Healthcare facility volume and evidence-based practice implementation in surgical care of patients with common

Kelsey B Montgomery¹, Nicole Rademacher¹, Joshua S Richman²

¹Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.

American Journal of Surgery

|November 29, 2025

Abstract

Background:

Implementation of evidence-based practices (EBPs) can serve as an indicator of quality for common cancers. This study evaluated the impact of hospital volume on EBP implementation for common cancers.

Methods:

This retrospective cohort study of adults who underwent curative-intent treatment for breast, colon, melanoma, and thyroid cancer from 2010 to 2020 used data from the National Cancer Database. Eight EBP measures, two per disease site, were evaluated across facility volume quartiles using mixed-effects logistic regression models adjusted for patient and facility characteristics.

Results:

There were 2,893,655 patients (breast n = 1,731,433, colon n = 481,858, melanoma. n = 418,841, thyroid n = 261,523) (median age 63). EBP implementation was higher at the highest-volume sites compared to lowest (range by measure: 71 %-95 % and 60 %-90 % respectively). The adjusted odds of receiving EBP was greater at higher-volume facilities for six of eight measures.

Conclusion:

Volume-associations in EBP implementation may influence system-level decision making around care allocation for common cancers.

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