Impact of hospital volume on risk-adjusted mortality following oesophagectomy in Japan

Nishigori, Tatsuto; Matsubara, Hiroaki; Okabe, Hiroshi; Toh, Yasushi; Matsubara, Hisahiro; Konno, Hiroyuki; Seto, Yasuyuki; Sakai, Yoshiharu

doi:10.1002/bjs.10307

Cited by 61 publications

(56 citation statements)

References 18 publications

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“…However, given the operative complexity of esophagectomy and the perioperative resources necessary to care for these patients, this procedure has become increasingly centralized at larger tertiary referral centers, which are more frequently represented in ACS‐NSQIP . Moreover, the rates of anastomotic leak (13.9%) and mortality (2.7%) reported here are similar to prior studies, varying anywhere from 2.96% to 21.9% and 1.0% to 11.6%, respectively . Third, the ACS‐NSQIP does not capture 100% of operative cases performed, which could result in selection bias .…”

Section: Discussionmentioning

confidence: 56%

“…Although this increase in volume was associated with a decrease in mortality, high morbidity rates remain problematic, and the Esophageal Complications Consensus Group recently reported that 59% of patients develop at least one postoperative complication . Anastomotic leaks are estimated to occur in 11.4% of patients after esophagectomy, making it the most common surgical complication, and the third most common complication overall, behind pneumonia (14.6%) and atrial dysrhythmias requiring intervention (14.5%) …”

Section: Introductionmentioning

confidence: 99%

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Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak.Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak.Results: Of 915 patients included, 83% were male and the median age was 64 years.Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak.Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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“…In Japan, a minimum hospital volume standard is used as an eligibility criterion for designated cancer care hospitals, and as an indicator to monitor their performance . The majority of studies on the volume‐outcome relationship previously conducted in Japan focused on a single cancer site . One study reported the volume‐survival relationship for multiple sites of cancer diagnosed in 1994‐1998; hospital volume was defined by the number of patients treated .…”

Section: Introductionmentioning

confidence: 99%

“…29 The majority of studies on the volume-outcome relationship previously conducted in Japan focused on a single cancer site. 21,[30][31][32][33][34][35] One study reported the volume-survival relationship for multiple sites of cancer diagnosed in 1994-1998; hospital volume was defined by the number of patients treated. 7 Since then, Osaka has changed in terms of its population structure, medical technology and cancer control policy, and has improved its cancer registry system.…”

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confidence: 99%

Hospital volume and postoperative 5‐year survival for five different cancer sites: A population‐based study in Japan

et al. 2020

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The relationship between hospital volume and patient outcome is globally known; thus, hospital volume is widely used as a quality indicator. In Japan, however, recent studies on this topic are scarce. The present study examined whether hospital surgery volume is associated with postoperative 5‐year survival among cancer patients. Using the Osaka Cancer Registry, we identified a sample of 86 145 patients who were diagnosed with cancer at any of five different sites (stomach, colorectum, lung, breast and uterus) and underwent surgeries between 2007 and 2011 in Osaka. We ranked hospitals by annual surgical volume, sorted patients in descending order by hospital volume, and assigned them into quartiles (high, medium, low and very low volume). We analyzed the association between hospital volume and 5‐year survival among 80 959 patients aged between 15 and 84 years using Cox proportional hazard models. Adjustments were made for characteristics of patients, type of surgery and adjuvant treatment received. The mortality hazard of patients treated at very low‐volume hospitals was 1.36‐1.82‐fold higher than that of patients treated at high‐volume hospitals. Absolute differences in adjusted survival rates between high‐volume and very low‐volume hospitals varied with the cancer site: 14.9 in stomach, 11.5 in colorectal, 10.8 in lung, 2.4 in breast and 3.3 in uterine cancers. Hospitals with lower surgery volumes showed higher mortality risks after cancer surgery than those with higher volumes. Monitoring site‐specific surgery volumes and referring patients from low‐volume to high‐volume hospitals may be beneficial for improving the long‐term survival of cancer patients.

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“…The reported data were results obtained at limited outstanding high‐volume facilities. Moreover, Nishigori et al reported that high‐volume hospitals had lower risk‐adjusted 30‐day and operative mortality rates compared with low‐volume hospitals. Data from the Japanese nationwide web‐based database included data on outcomes not only from high‐volume, but also from low‐volume hospitals, so that data from the Japanese nationwide web‐based database may not reflect the actual reduced invasiveness of MIE .…”

Section: Minimally Invasive Esophagectomy Versus Open Esophagectomymentioning

confidence: 99%

Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive?

Oshikiri

Takiguchi

Miura

et al. 2018

Annals of Gastroent Surgery

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Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal cancer. However, it is one of the most invasive procedures with high morbidity. To reduce invasiveness, minimally invasive esophagectomy (MIE), which includes thoracoscopic, laparoscopic, mediastinoscopic, and robotic surgery, is becoming popular worldwide. Thoracoscopic esophagectomy in the prone position is ergonomic for the surgeon and has better perioperative arterial oxygen pressure/fraction of inspired oxygen (P/F) ratio. Thoracoscopic esophagectomy in the left decubitus position is easy to introduce because it is similar to standard right posterolateral open esophagectomy (OE) in position. It has a relatively short operative time. Laparoscopic approach could potentially have a substantial effect on pneumonia prevention under the condition of thoracotomy. Mediastinoscopic surgery has the potential to reduce pulmonary complications because it can avoid a transthoracic procedure. In robotic surgery, in the future, less recurrent laryngeal nerve palsy will be expected as a result of polyarticular fine maneuvering without human tremors. In studies comparing MIE with OE, mediastinoscopic surgery and robotic surgery are usually not included; these studies show that MIE has a longer operative time and less blood loss than OE. MIE is particularly beneficial in reducing postoperative respiratory complications such as atelectasis, despite no dramatic decrease in pneumonia. Reoperation might occur more frequently with MIE. There is no significant difference in mortality rate between MIE and OE. It is important to recognize that the advantages of MIE, particularly “less invasiveness”, can be of benefit at facilities with experienced medical personnel.

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Impact of hospital volume on risk-adjusted mortality following oesophagectomy in Japan

Abstract: In Japan, high-volume hospitals had lower risk-adjusted 30-day and operative mortality rates following oesophagectomy compared with low-volume hospitals.

Cited by 61 publications

References 18 publications

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hospital volume and postoperative 5‐year survival for five different cancer sites: A population‐based study in Japan

Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive?

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