Is a clear benefit in survival enough to modify patient access to the surgery service? A retrospective analysis in a cohort of gastric cancer patients

Altini, Mattia; Carretta, Elisa; Morgagni, Paolo; Carradori, Tiziano; Ciotti, Emanuele; Prati, Elena; Garcea, Domenico; Amadori, Dino; Falcini, Fabio; Nanni, Oriana

doi:10.1007/s10120-014-0346-2

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…This may contribute to the conflicting associations between post-operative mortality following gastrectomy and hospital volume reported in the literature. 4,9,10,12,[19][20][21][22] Our results confirm the importance of a high hospital service capability in improving the risk of post-operative 30-and 90-day mortality rates following gastrectomy and suggests that, among Australian hospitals with a high service capability, high surgical volume may not bring additional improvement in mortality rates following gastrectomy. However, we acknowledge that only 12% of our study cohort had surgery in hospitals with LVHS and worse mortality in these centres may be reported in future studies conducted over a longer period.…”

Section: Discussionsupporting

confidence: 61%

“…To date, no population‐level study, comparing post‐operative mortality between high‐ and low‐volume centres, following gastrectomy, has specifically accounted for the hospital service capability within hospital volume groups. This may contribute to the conflicting associations between post‐operative mortality following gastrectomy and hospital volume reported in the literature . Our results confirm the importance of a high hospital service capability in improving the risk of post‐operative 30‐ and 90‐day mortality rates following gastrectomy and suggests that, among Australian hospitals with a high service capability, high surgical volume may not bring additional improvement in mortality rates following gastrectomy.…”

Section: Discussionsupporting

confidence: 59%

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Impact of hospital resection volume and service capability on post‐operative mortality following gastrectomy

Narendra

Baade

Aitken

et al. 2019

ANZ Journal of Surgery

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Background Improved post‐operative mortality following gastrectomy for cancer in hospitals with higher resection volumes has not been reported in Australia. Using a population‐based study in Queensland, we aimed to compare post‐operative mortality following gastrectomy between high‐ and low‐volume hospitals stratified by their service capability. Methods All patients undergoing gastrectomy for adenocarcinoma in Queensland between 2001 and 2015 were obtained from the Queensland Oncology Repository. Hospital service capability was defined using the 2015 Australian Institute of Health and Welfare hospital peer groupings. Hospitals were grouped into ‘high‐volume (≥5 gastrectomies annually), high service capability’ (HVHS); ‘low‐volume (<5), high service capability’; and ‘low‐volume, low service capability’ (LVLS). Negative binomial regression models were used to compare 30‐ and 90‐day mortality rates between hospital groups adjusting for age, sex, socio‐economic status, Charlson and American Society of Anesthesiologists scores, treatment regimen, stage and time‐period. Potential mediation of mortality differences between hospital groups due to differences in the type of gastrectomy performed was also examined. Results LVLS hospitals have higher adjusted 30‐day (incidence rate ratio (IRR) 2.97, 95% confidence interval (CI) 1.65–5.35) and 90‐day (IRR 1.95, 95% CI 1.23–3.09) mortality rates compared with HVHS hospitals. There is no significant difference in adjusted 30‐day (IRR 1.16, 95% CI 0.48–2.79) and 90‐day (IRR 1.12, 95% CI 0.59–2.13) mortality rates comparing low‐volume, high service capability hospitals with HVHS hospitals. The type of gastrectomy performed did not significantly influence differences in mortality compared between hospital groups. Conclusion In the Australian environment, post‐operative mortality following gastric cancer surgery may be optimized by centralizing gastrectomy away from hospitals characterized by LVLS.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 59%

Impact of hospital resection volume and service capability on post‐operative mortality following gastrectomy

Narendra

Baade

Aitken

et al. 2019

ANZ Journal of Surgery

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“…Between 2005 and 2011, in five of the seven years, more than 21 total gastrectomies were performed per year, whereas in previous years this had only occurred in 1993 and 1994. Although 21 procedures is the number used to characterize highvolume centers in gastrectomies, 8 the fact that it had already been exceeded only with total resections can justify better technical standardization and, consequently, better results.…”

Section: Discussionmentioning

confidence: 98%

Total Gastrectomy for Gastric Cancer: An Analysis of Postoperative and Long-Term Outcomes Through Time

et al. 2014

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“…The number of patients in the included studies ranged from 188 to 145 523, with a total of 586 993 patients. Four studies were prospective 36 , 41 , 58 , 60 , and 26 were retrospective cohort studies 5 – 10 , 32 – 35 , 37 – 40 , 42 , 53 – 57 , 59 , 61 – 65 . Nine studies were from Eastern countries 5 , 6 , 32 , 34 , 36 , 42 , 55 , 57 , 62 , and 21 were from Western countries 7 – 10 , 33 , 35 , 37 – 41 , 53 , 54 , 56 , 58 – 61 , 63 – 65 .…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were prospective 36 , 41 , 58 , 60 , and 26 were retrospective cohort studies 5 – 10 , 32 – 35 , 37 – 40 , 42 , 53 – 57 , 59 , 61 – 65 . Nine studies were from Eastern countries 5 , 6 , 32 , 34 , 36 , 42 , 55 , 57 , 62 , and 21 were from Western countries 7 – 10 , 33 , 35 , 37 – 41 , 53 , 54 , 56 , 58 – 61 , 63 – 65 . The postoperative mortality in the included studies ranged from 0.07 to 17.7% in different categories.…”

Section: Resultsmentioning

confidence: 99%

Association between hospital surgical case volume and postoperative mortality in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis

Ning

Zhao

et al. 2023

International Journal of Surgery

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Background: Postoperative mortality is an important indicator for evaluating surgical safety. Postoperative mortality is influenced by hospital volume; however, this association is not fully understood. This study aimed to investigate the volume–outcome association between the hospital surgical case volume for gastrectomies per year (hospital volume) and the risk of postoperative mortality in patients undergoing a gastrectomy for gastric cancer. Methods: Studies assessing the association between hospital volume and the postoperative mortality in patients who underwent gastrectomy for gastric cancer were searched for eligibility. Odds ratios were pooled for the highest versus lowest categories of hospital volume using a random-effects model. The volume–outcome association between hospital volume and the risk of postoperative mortality was analyzed. The study protocol was registered with Prospective Register of Systematic Reviews (PROSPERO). Results: Thirty studies including 586 993 participants were included. The risk of postgastrectomy mortality in patients with gastric cancer was 35% lower in hospitals with higher surgical case volumes than in their lower-volume counterparts (odds ratio: 0.65; 95% CI: 0.56–0.76; P<0.001). This relationship was consistent and robust in most subgroup analyses. Volume–outcome analysis found that the postgastrectomy mortality rate remained stable or was reduced after the hospital volume reached a plateau of 100 gastrectomy cases per year. Conclusions: The current findings suggest that a higher-volume hospital can reduce the risk of postgastrectomy mortality in patients with gastric cancer, and that greater than or equal to 100 gastrectomies for gastric cancer per year may be defined as a high hospital surgical case volume.

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Is a clear benefit in survival enough to modify patient access to the surgery service? A retrospective analysis in a cohort of gastric cancer patients

Cited by 6 publications

References 28 publications

Impact of hospital resection volume and service capability on post‐operative mortality following gastrectomy

Impact of hospital resection volume and service capability on post‐operative mortality following gastrectomy

Total Gastrectomy for Gastric Cancer: An Analysis of Postoperative and Long-Term Outcomes Through Time

Association between hospital surgical case volume and postoperative mortality in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis

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