Hospital Volume and Quality of Laparoscopic Gastrectomy in Japan

Abstract

Background: Laparoscopic gastrectomy (LG) has become the prevailing surgery of choice for gastric cancer, but the impact of hospital volume or operating room (OR) time has not been evaluated. An observational study was conducted to assess the quality of LG based on hospital volume and OR time. Methods: 3,054 LG patients were enrolled in 420 hospitals throughout Japan. Analyzed variables included patient demographics, complications, use of stapling devices or chemotherapy, hospital volume, and teaching status. Hospitals were categorized into high- (≥4 LG per month), intermediate- (1–3) and low- (<1) volume hospitals. Multivariate analysis was used to measure hospital volume and OR time impact. Results: 259 laparoscopic total gastrectomies (LTGs) were performed. Complications were observed in 269 cases (8.8%). High-volume hospitals treated less severe cases. OR time, but not hospital volume, was associated with complications. Hospital volume, teaching status and stapling devices explained variations in OR time. Conclusion: OR time was a more significant predictor of complications than hospital volume. OR time was consumed more in the employment of stapling devices and LTG. To promote LG efficiency, training curricula highlighting the applicability of these techniques should be considered by clinical experts.

Quality indicators for oesophageal and gastric cancer: a population-based study in Belgium, 2004-2008

“…Sixteen relevant articles were retrieved from the Medline search: eight for GC (Peeters & van de Velde 2003;Meyer 2005;van Krieken & Nagtegaal 2005;Helyer et al 2007;Kuwabara et al 2009;Qureshi et al 2009;Verlato et al 2009;Jensen et al 2010) and eight for OC (Tanisada et al 2002;Lerut et al 2005;Teshima & Japanes 2005;Gouma & Busch 2007;Wouters et al 2008;Coe et al 2009;Wouters et al 2009;Courrech Staal et al 2010), which were evaluated based on their full text. Globally, 28 QIs were retrieved from these published sources.…”

Quality of Care Indicators for the Surgical Treatment of Gastric Cancer: A Systematic Review

“…In the majority of these studies, the effect of hospital volume on postoperative mortality was investigated, with variable results. 12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Of note, in most large studies, a benefit for high annual hospital volume was found, whereas in smaller studies no difference between high-volume and low-volume hospitals was detected (Fig. 2).…”

Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume?

“…To the best of our knowledge, most studies showed no relationship between hospital volume and postoperative morbidity 18, 20, 21, 26, 27, 28. Morbidity rate is generally affected by patient characteristics such as comorbidities, acuity of presentation, and age 29.…”