TY - JOUR
T1 - Association of surgeon and hospital volume with postoperative mortality after total gastrectomy for gastric cancer
T2 - data from 71,307 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
N1 - Funding Information:
Hiroaki Miyata and Hiroyuki Yamamoto are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., and Nipro Co. None of these organizations had any role in the design and conduct of the study, data collection, data analysis, data management, data interpretation, or the preparation, review, and approval of this manuscript. This work was supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science, grant number 20K07594 (For M.I.).
PY - 2020
Y1 - 2020
N2 - Background: Despite interest in surgeon and hospital volume effects on total gastrectomy (TG), clinical significance has not been confirmed in a large-scale population. This study aimed at clarifying the association of surgeon and hospital volume on postoperative mortality after TG for gastric cancer among Japanese patients in National Clinical Database (NCD). Methods: Between 2011 and 2015, we retrospectively extracted data on TG for gastric cancer from the NCD. The primary outcome was operative mortality. We divided surgeon volume as the number of TGs performed by a patient’s surgeon in the previous year: S1 (0–2 cases), S2 (3–9), S3 (10–25), S4 (26–79) and hospital volume by the number of TGs performed in the previous year: H1 (0–11 cases), H2 (12–26), H3 (27–146). We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (OR) estimated from a hierarchical logistic regression model. Results: We analyzed 71,307 patients at 2051 institutions. Low-volume surgeons and hospitals had significantly older and poorer-risk patients with various comorbidities. The operative mortality rate decreased with surgeon volume, 2.5% in S1 and 0.6% in S4. The operative mortality was 3.1% in H1, 1.7% in H2, and 1.2% in H3. After risk adjustment for surgeon, hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (H3: OR = 0.53, 95% CI 0.43–0.63). Conclusions: We demonstrate hospital volume has an impact on postoperative mortality after TG in a nationwide population study. These findings suggest centralization may improve outcomes after TG.
AB - Background: Despite interest in surgeon and hospital volume effects on total gastrectomy (TG), clinical significance has not been confirmed in a large-scale population. This study aimed at clarifying the association of surgeon and hospital volume on postoperative mortality after TG for gastric cancer among Japanese patients in National Clinical Database (NCD). Methods: Between 2011 and 2015, we retrospectively extracted data on TG for gastric cancer from the NCD. The primary outcome was operative mortality. We divided surgeon volume as the number of TGs performed by a patient’s surgeon in the previous year: S1 (0–2 cases), S2 (3–9), S3 (10–25), S4 (26–79) and hospital volume by the number of TGs performed in the previous year: H1 (0–11 cases), H2 (12–26), H3 (27–146). We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (OR) estimated from a hierarchical logistic regression model. Results: We analyzed 71,307 patients at 2051 institutions. Low-volume surgeons and hospitals had significantly older and poorer-risk patients with various comorbidities. The operative mortality rate decreased with surgeon volume, 2.5% in S1 and 0.6% in S4. The operative mortality was 3.1% in H1, 1.7% in H2, and 1.2% in H3. After risk adjustment for surgeon, hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (H3: OR = 0.53, 95% CI 0.43–0.63). Conclusions: We demonstrate hospital volume has an impact on postoperative mortality after TG in a nationwide population study. These findings suggest centralization may improve outcomes after TG.
KW - Gastric cancer
KW - Hospital volume
KW - Surgeon volume
KW - Total gastrectomy
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U2 - 10.1007/s10120-020-01127-8
DO - 10.1007/s10120-020-01127-8
M3 - Article
AN - SCOPUS:85092378122
JO - Gastric Cancer
JF - Gastric Cancer
SN - 1436-3291
ER -