Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship

Choi, Hyang Suk; Yang, Seong Yoon; Cho, Hee Seung; Kim, Woorim; Park, Sohee; Han, Kyu Tae

doi:10.1186/s12957-017-1203-7

Cited by 18 publications

(24 citation statements)

References 24 publications

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“…Several primary studies indicate a positive relationship between hospital volume and clinical outcomes for different surgical procedures: 1–4 indeed, the higher the operative volume, the better the patient’s outcomes (mainly the mortality). The positive volume-outcome relationship led researchers to recommend the creation of thresholds of surgeries in order to limit centres with low activity 5 6 7 These conclusions are consistent with the ones already drawn by scientific authorities as the Expert panel on Weight Loss Surgery for bariatric surgery, 8 or with policies implemented in a few countries such as France in 2007. These thresholds must be taken into account by policymakers when they organise the sanitary map.…”

Section: Introductionsupporting

confidence: 67%

Assessing the hospital volume-outcome relationship in surgery: a scoping review protocol

Levaillant¹,

Marcilly

Levaillant³

et al. 2020

BMJ Open

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IntroductionEven if a positive volume-outcome correlation in surgery is mostly admitted in many surgical fields, the various ways to assess this relationship make it difficult for researchers and policymakers to use it. Our aim is therefore to provide an overview of the way hospital volume-outcome relationship was assessed. Through this overview, our goal is to identify potential gaps in the assessment of this relationship, to help researchers who want to pursue work in this field and, ultimately, to help policy makers interpret such analyses.Methods and analysisThis review will be conducted using the six stages of the scoping review method: identifying the research question, searching for relevant studies, selecting studies, data extraction, collating, summarising and reporting the results and concluding. This review will address all the key questions used to assess the volume-outcome relationship in surgery.Primary research papers investigating the hospital volume-outcome relationship from 2009 will be included. Studies only looking at surgeons’ volume-outcome relationship or studies were the volume variable is not individualisable will be excluded.Both MEDLINE and Scopus will be searched along with grey literature. Two researchers will perform all the stages of the review: screen the titles and abstracts, review the full text of selected articles to determine final inclusions and extract the data. The results will be summarised quantitatively using numerical counts.Ethical considerations and disseminationReviews of published articles are considered secondary analysis and do not need ethical approval. The findings will be disseminated through multiple channels like conferences and peer-reviewed journals.

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Section: Introductionsupporting

confidence: 67%

Assessing the hospital volume-outcome relationship in surgery: a scoping review protocol

Levaillant¹,

Marcilly

Levaillant³

et al. 2020

BMJ Open

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“…28,[149][150][151][152] However, our findings are also consistent with the similar survival reported following gastrectomy in several western population level studies comparing high and low resection volume hospitals. [149][150][151][152] Following oesophagectomy, our findings of better survival in high-volume centers are in keeping with the results of two large population-level studies based in the USA 124,147 , and with two recent meta-analyses that report a 20% lower pooled hazard of long-term mortality in high-volume centers when compared to low-volume centers. 30,148 However, the thresholds defining high resection volumes in these studies are higher than those we used and range between 14 and 17 resections annually.…”

Section: Resultssupporting

confidence: 87%

“…While, this may relate to low numbers of resections in our study cohort compared with international series 28,124 , our findings are consistent with the results reported in several western population level studies with large patient cohorts comparing high-and low-resection volume hospitals performing gastrectomy for cancer. [149][150][151][152] This may reflect the better overall prognosis of gastric cancers 14, 125-127 compared with oesophageal 123,124 or pancreatic cancer 17,18 , as well as the surgery being generally considered less technically challenging compared with oesophagectomy and pancreaticoduodenectomy. For oesophagectomy and pancreaticoduodenectomy, in our study, there was better longer-term survival following treatment in high-volume centres which performed at least six annual procedures, compared with centres characterised by lower resection volumes.…”

Section: Discussionmentioning

confidence: 99%

“…However, for these malignancies, the reported associations between higher hospital resection volume and better long-term survival are conflicting. 30,34,35,124,[147][148][149][150][151][152][153][154] This may relate to a number of factors including heterogenous volume thresholds used to define a high-volume center, as well as a lack of adjustment for early post-operative mortality, hospital service-capability or essential case-mix variables including cancer stage in many population-level studies. 30,146,153 In Australia, an association between a "high" hospital resection volume and better quality of surgery and long-term survival has yet to be established for oesophageal and gastric cancers.…”

Section: Introductionmentioning

confidence: 99%

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An assessment of the impacts of centralising complex upper-gastrointestinal surgery in Queensland

Narendra¹

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Introduction: Better outcomes following surgery for oesophageal, gastric and pancreatic cancers in highvolume centres compared with low-volume centres have been reported in population-level studies based in the United States of America (USA) and Europe. In some regions, this has led to the centralisation of the surgery for these cancers to high-volume centres which has been reported to be associated with improvements in post-operative outcomes. In Australia, centralisation of surgery for these cancers is controversial due to a lack of robust data in favour of a volume-outcome relationship within Australian centres and concerns regarding access to care for regional and rural populations. This is of particularly relevance as rural and regional populations are reported to have a higher risk of developing many cancers, compared with their urban counterparts. We aimed to compare surgical outcomes between hospitals grouped by volume and service-capability and compared the incidence and survival following the diagnosis and treatment of upper gastrointestinal cancers between areas grouped by access to high-volume care. Methods: Data on all patients diagnosed with oesophageal, gastric and pancreatic cancers in Queensland, between 2001 and 2015, were obtained from the Queensland Oncology Repository. Hospitals were grouped by: resection volume (High = six or more oesophagectomies or pancreaticoduodenectomies or five or more gastrectomies annually; Low = less than six; less than five); and service-capability (High= Principle Referral hospitals or Private Group A hospitals; Low = All other hospitals). Patients were grouped according to their access to a high-volume treatment centre, calculated as road distance from the patient's residential location to the closest high-volume centre (<100 km,100-199 km, 200-399 km and 400 or more km). Multivariable Poisson regression models were used to compare adjusted cancer incidence between access groups and to compare post-operative mortality between hospital groups. Multivariable logistic regression models were used to compare quality of surgery between hospital groups, and flexible parametric survival models and Cox-proportional hazard models were used to compare cancer-specific and overall survival between access groups and hospital groups respectively.

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“…[17] Therefore, this study obtained data on acute hemorrhagic stroke patients for a 5-year period (2009–2013) from the HIRA for analysis. [18,19] Acute hemorrhagic stroke patients were defined as those with a hemorrhagic stroke as the primary disease (International Classification of Disease, 10th version [ICD-10]: I60, I61, and I62) who were admitted to the hospital via the emergency department within 7 days of the onset of symptoms. Patients <18 years were excluded, as stroke is very rare in this age group.…”

Section: Methodsmentioning

confidence: 99%

Association between volume of surgery for acute hemorrhagic stroke and mortality

Lee

2018

Medicine

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This study aimed to investigate the association between volume of surgery and mortality in relation to interventions for acute hemorrhagic stroke, namely craniotomy and trephination.We obtained data on acute hemorrhagic stroke patients for a 5-year period (2009-2013) from the Health Insurance Review and Assessment Service. Hospitals were classified into 3 categories according to volume of surgery (low, medium, high). To avoid intentionally setting a cutoff, we placed the hospitals in order from those with high volume of surgery to those with low volume of surgery and divided them into 3 groups (tertile) according to the number of patients. The covariates were age, sex, hemorrhagic stroke site, type of health insurance, intensive care unit admission, history of hypertension, and Charlson comorbidity index. Multiple logistic regression analysis was performed with statistical significance set at 5%.A total of 41,917 patients who underwent craniotomy (n = 20,982) or trephination (n = 20,935) for acute hemorrhagic stroke were analyzed according to hemorrhage site (subarachnoid and others). The results showed that mortality from acute hemorrhagic stroke decreased with increasing volume of surgery. For subarachnoid hemorrhage, the odds ratios of the medium- and high-volume surgery groups were significantly lower (0.74 and 0.59, respectively) for mortality within 7 days of admission, and were also significantly lower (0.78 and 0.68) for mortality within 30 days of admission than that of the low-volume surgery group. The results for other hemorrhage sites were similar. The association between mortality and volume of surgery was more evident in the craniotomy group. Although this study was limited to a single country (South Korea), it partially addressed the shortcomings of previous studies by analyzing a nationwide database and examining all types of hemorrhagic strokes.

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Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship

Cited by 18 publications

References 24 publications

Assessing the hospital volume-outcome relationship in surgery: a scoping review protocol

Assessing the hospital volume-outcome relationship in surgery: a scoping review protocol

An assessment of the impacts of centralising complex upper-gastrointestinal surgery in Queensland

Association between volume of surgery for acute hemorrhagic stroke and mortality

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