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

Masaaki Iwatsuki, Hiroyuki Yamamoto, Hiroaki Miyata, Yoshihiro Kakeji, Kazuhiro Yoshida, Hiroyuki Konno, Yasuyuki Seto, Hideo Baba

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Gastrectomy
Information Systems
Stomach Neoplasms
Mortality
Odds Ratio
Confidence Intervals
Logistic Models
High-Volume Hospitals
Risk Adjustment
Population
Surgeons
Databases

Keywords

  • Distal gastrectomy
  • Gastric cancer
  • Hospital volume

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

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. / Iwatsuki, Masaaki; Yamamoto, Hiroyuki; Miyata, Hiroaki; Kakeji, Yoshihiro; Yoshida, Kazuhiro; Konno, Hiroyuki; Seto, Yasuyuki; Baba, Hideo.

In: Gastric Cancer, 01.01.2018.

Research output: Contribution to journalArticle

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title = "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.",
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T1 - 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

AU - Iwatsuki, Masaaki

AU - Yamamoto, Hiroyuki

AU - Miyata, Hiroaki

AU - Kakeji, Yoshihiro

AU - Yoshida, Kazuhiro

AU - Konno, Hiroyuki

AU - Seto, Yasuyuki

AU - Baba, Hideo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Distal gastrectomy

KW - Gastric cancer

KW - Hospital volume

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