{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:29:25Z","timestamp":1786418965623,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HS028975"],"award-info":[{"award-number":["HS028975"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["T32 CA180984"],"award-info":[{"award-number":["T32 CA180984"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Studies assessing the impact of advanced practice providers (APPs), including nurse practitioners and physician assistants, have demonstrated a similar quality of care for patients admitted to the hospital for medical diagnoses. However, no studies have examined the relationship between APP integration and morbidity after cancer surgery. This study assesses the relationship between APP staffing intensity and patient outcomes following major abdominal cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used 100% national Medicare data (2010\u20132019) to assess the link between APP staffing intensity and surgical outcomes for patients undergoing major abdominal cancer surgery, including cystectomy, colectomy, hepatectomy, esophagectomy, gastrectomy, and pancreatectomy. The primary exposure was the ratio of APPs per 100 hospital beds, and patients were empirically divided into tertiles. Outcomes included readmission rates and length of stay, adjusted for patient and hospital level factors. As a secondary outcome, we measured 30\u2010day perioperative mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We analyzed 326,547 colectomy patients, 50,400 cystectomy patients, 14,112 esophagectomy patients, 27,152 gastrectomy patients, 15,225 hepatectomy patients, and 46,287 pancreatectomy patients. Surgery at centers with the most advanced practice providers per beds (i.e., the highest tertile) was associated with shorter length of stays for most surgery types analyzed. Unadjusted 30\u2010day readmissions tended to be lower in patients undergoing more complex procedures, such as esophagectomy (21.5% vs. 24.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) but not for the less complex operations studied, such as colectomy (13.6% vs. 13.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.22). However, clinical differences in outcomes were lost on analyses controlling for patient and hospital factors (IRR length of stay: 0.98\u20131.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002\u2013087) (OR readmissions: 0.86\u20131.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003\u20130.80).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The relationship between hospital APP staffing intensity and surgical outcomes was varied and heterogenous. However, differences in outcomes were primarily explained by hospital factors. More work is needed to determine process measures associated with the deployment of inpatient APPs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71959","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:33:54Z","timestamp":1782700434000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Number of Hospital Advanced Practice Providers and Surgical Morbidity"],"prefix":"10.1002","volume":"15","author":[{"given":"Christopher P.","family":"Dall","sequence":"first","affiliation":[{"name":"Department of Urology Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Urology Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology Massachusetts General Hospital  Boston 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University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahakn B.","family":"Shahinian","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"},{"name":"Division of Nephrology, Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Ellimoottil","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent K.","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150131917736634"},{"issue":"8","key":"e_1_2_11_3_1","first-page":"366","article-title":"Current Evidence and Controversies: Advanced Practice Providers in Healthcare","volume":"25","author":"Sarzynski E.","year":"2019","journal-title":"American Journal of Managed 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