Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

Abstract

Background Despite interest in surgeon and hospital volume effects on distal gastrectomy, clinical significance has not been confirmed in a large-scale population. We studied to clarify the effects of surgeon and hospital volume on postoperative mortality after distal gastrectomy for gastric cancer among Japanese patients in a nationwide web-based data entry system. Methods We extracted data on distal gastrectomy for gastric cancer from the National Clinical Database between 2011 and 2015. The primary outcome was operative mortality. Hospital volume was divided into 3 tertiles: low (1-22 cases per year), medium (23-51) and high (52-404). Surgeon volume was divided into the 5 groups: 0-3, 4-10, 11-20, 21-50, 51 + cases per year. We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (ORs) estimated from a hierarchical logistic regression model. Results We analyzed 145,523 patients at 2182 institutions. Operative mortality was 1.9% in low-, 1.0% in medium-and 0.5% in high-volume hospitals. The operative mortality rate decreased definitively with surgeon volume, 1.6% in the 0-3 group and 0.3% in the 51 + group. After risk adjustment for surgeon and hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (medium: OR 0.64, 95% CI 0.56-0.73, P < 0.001; high: OR 0.42, 95% CI 0.35-0.51, P < 0.001). Conclusions We demonstrate that hospital volume can have a crucial impact on postoperative mortality after distal gastrectomy compared with surgeon volume in a nationwide population study. These findings suggest that centralization may improve outcomes after distal gastrectomy.

Preoperative risk factors for postoperative intra-abdominal infectious complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database

“…Male, obese, advanced cancer stage, and total gastrectomy strongly affected morbidity incidence. Patients were stratified into three risk groups (low-risk group, 0-7; middle-risk group, 8-15; and high-risk group, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] according to the SIGN score. The predicted probabilities for PIIC in the low-, middle-, and high-risk groups were 1.8%, 4.1%, and 7.8%, respectively, using the development cohort.…”

“…The Japanese Society of Gastroenterological Surgery (JSGS) registry started to collect data in 2011 and has accumulated over 1.2 million gastroenterological surgery records from over 5000 hospitals throughout Japan. The endpoints of previous research in gastric cancer using the NCD were mainly mortality or overall morbidity, and PIIC was not yet recognized [2,3,[14][15][16][17][18][19][20][21].…”

Profiles of institutional departments affect operative outcomes of eight gastroenterological procedures

“…We then focused on the association of institutional volume with operative outcomes, because some studies incorporating risk-adjusted models and using NCD data have investigated the association between institutional patient volume and operative outcomes for Eso, 22 DG, 23 Hx, 24 and PD. 25 Prior to the analysis, Although it is true that institutional volume has an impact on operative outcomes, we hypothesized that the departments' structural and procedural characteristics on how they care for their surgical patients are vital for the operative outcomes.…”

Development and validation of grade‐based prediction models for postoperative morbidity in gastric cancer resection using a Japanese web‐based nationwide registry

“…When using these models, the quality of care of hospitals should be considered because a volume outcome relationship has been reported for gastric cancer surgeries . The present models provide an average risk in Japan.…”