Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment

Abstract

Purpose We investigated the risk factors for early postoperative complications after gastric cancer surgery. Materials and methods The data from a total of 273 patients with gastric cancer were analyzed by univariate and multivariate analysis. We applied physiological and operative severity score for the enumeration of morbidity and mortality (POSSUM) to compare risk-adjusted surgical outcomes among different surgical units. Results Among the preoperative variables, patient gender, chronic obstructive pulmonary disease, surgical unit, and intraoperative blood loss were independent risk factors for a higher rate of postoperative complications. There were significant differences in complication rates among different surgical units (P=0.001). The observed-to-expected morbidity ratio (O-to-E ratio) ranged from 0.81 to 1.63. Units with low surgical work volume had higher complication rates. Postoperative length of stay was significantly shorter (P=0.000) and the rate of moderate and severe complications was significantly lower (P=0.001) in specialized unit.Conclusions POSSUM is a valid system for risk-adjusted evaluation of surgical outcomes. We conclude that surgical experience and work volume greatly influence the outcome, with overall surgical outcome in specialized centers superior to that in other units. Hence, gastric cancer surgery should be performed in specialized centers. Risk factors identified in this study need further confirmation by a prospective study involving a larger cohort.

The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

“…Several studies suggested that GC surgery should be performed in specialized centers as they found the rate of mortality and morbidity was significantly lower if GC patients were operated on by surgeons with high caseloads or coming from specialized units [15][16][17]. Our result was different from these studies.…”

Postoperative Pulmonary Complications and Associated Factors among Surgical Patients

“…This finding is consistent with study conducted by Kumar et al [31] in which intraoperative blood loss showed significant association with postoperative pulmonary complications. The possible explanation for this could be because of increased risk of transfusion which decreases immunity.…”

“…This is also consistent with study conducted by Daniel et al [30] where use of epidural analgesia has brought significant reduction in postoperative pneumonia as compared to those patients who were not given epidural analgesia in patients undergoing thoracic and abdominal surgeries [31]. This could be explained by impairment of effective breathing and coughing reflexes due to pain especially in procedures done on upper abdomen and intra thorax, thereby leading to hypoventilation and sputum retention; which intern lead to postoperative pulmonary complications as hypoxia, atelectasis and pneumonia.…”

Institutional variation in short- and long-term outcomes after surgery for gastric or esophagogastric junction adenocarcinoma: correlative study of two randomized phase III trials (JCOG9501 and JCOG9502)

“…We found a positive relationship between higher hospital volume and both lower morbidity in JCOG9501 and reduced blood loss in [29]. Two other studies also showed a positive relationship between surgeon volume and shortterm outcomes [30,31]. Our study showed nonstatistically significant correlations between surgeon volume and the number of dissected lymph nodes and blood loss volume.…”