Relationship Between Volume and In-hospital Mortality in Digestive Oncological Surgery

Pérez-López, Paloma; Baré, Marisa; Touma-Fernández, Ángel; Sarría‐Santamera, Antonio

doi:10.1016/j.cireng.2016.02.019

Cited by 7 publications

(5 citation statements)

References 23 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%

“…Our study has several strengths including being population based and assessing a large number of patients, as well as adjusting for a wide variety of factors that may confound the relationships between hospital volume and service capability with post‐operative mortality. The limitations include the lower numbers of gastric resections and deaths compared with other published series, which has resulted in wide CIs around the IRR for some comparisons. Data on individual patient socio‐economic status were not available within our data set and the proxy measure of area‐level socio‐economic disadvantage may have misclassified some patients which may account for the unexpectedly higher 90‐day mortality seen in patients with Middle socio‐economic status.…”

Section: Discussionmentioning

confidence: 97%

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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%

Section: Discussionmentioning

confidence: 97%

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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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“…Improved outcomes associated with increased surgeon and institutional pancreatectomy volumes have led to the regionalization of this complex surgery to high‐volume centres. Whether policy‐mandated or happening naturally, regionalization of surgical care for pancreatic adenocarcinoma to high‐volume centres has become a reality in many healthcare systems. Although patients are willing to travel to high‐volume centres to seek improved outcomes, they also highly value care closer to home when comparable quality of care and outcomes can be provided .…”

Section: Introductionmentioning

confidence: 99%

Population-based study of the impact of surgical and adjuvant therapy at the same or a different institution on survival of patients with pancreatic adenocarcinoma

et al. 2018

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BackgroundPancreatic cancer surgery is increasingly regionalized in high‐volume centres. Provision of adjuvant chemotherapy in the same institution can place a burden on patients, whereas receiving adjuvant chemotherapy at a different institution closer to home may create disparities in care. This study compared long‐term outcomes of patients with pancreatic adenocarcinoma receiving adjuvant chemotherapy at the institution where they had undergone surgery with outcomes for those receiving chemotherapy at a different institution.MethodsThis was a population‐based study of patients receiving adjuvant chemotherapy after resection of pancreatic adenocarcinoma performed at ten designated hepatopancreatobiliary centres in Ontario, Canada, between 2004 and 2014. Patients were divided into those receiving chemotherapy at the same institution as surgery or a different institution from where surgery was performed. The primary outcome was overall survival (OS). Multivariable Cox regression assessed the association between OS and each chemotherapy group, adjusted for potential confounders.ResultsOf 589 patients, 374 (63·5 per cent) received adjuvant chemotherapy at the same institution as surgery. After adjusting for age, sex, co‐morbidity, socioeconomic status, rural living, tumour stage, margin positivity and year of surgery, the location of adjuvant chemotherapy was not independently associated with OS (hazard ratio 1·03, 95 per cent c.i. 0·85 to 1·24). For patients who underwent chemotherapy at a different institution, mean travel distance to receive chemotherapy was less (22·9 km) than that needed for surgery (106·7 km).ConclusionAfter pancreatectomy for pancreatic adenocarcinoma at specialized hepatopancreatobiliary surgery centres, OS was not affected by the location of the centre delivering adjuvant chemotherapy. Receiving this treatment in a local centre reduced patients' travel burden.

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“…Importantly, the process of digitizing the healthcare system must continue, as many post-Soviet countries currently lack comprehensive health information systems ( 15 ). Additionally, there is a need to shift focus from administratively monitoring outputs to identifying relevant outcomes, analyzing potential origins or impacts of poor performance, and implementing ambitious quality improvement programs ( 16 ). Aside from the introduction of advanced technologies, political stability could substantially contribute to a better healthcare model.…”

mentioning

confidence: 99%

Editorial: Public health challenges in post-Soviet countries during and beyond COVID-19

Glushkova,

Semenova,

Sarria-Santamera

2023

Front. Public Health

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Relationship Between Volume and In-hospital Mortality in Digestive Oncological Surgery

Cited by 7 publications

References 23 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

Population-based study of the impact of surgical and adjuvant therapy at the same or a different institution on survival of patients with pancreatic adenocarcinoma

Editorial: Public health challenges in post-Soviet countries during and beyond COVID-19

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