Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan

Kazuaki Kuwabara, Shinya Matsuda, Kiyohide Fushimi, Koichi B. Ishikawa, Hiromasa Horiguchi, Kenji Fujimori, Hideo Yasunaga, Hiroaki Miyata

研究成果: Article

20 引用 (Scopus)

抄録

Objective: In this community-based study, we assessed the advantages of laparoscopic gastrectomy (LG) and the impact of volume-related hospital characteristics on gastrectomy care. Background: The quality of gastrectomy care and the potential effects of volume-related hospital characteristics on gastrectomy care have not been comprehensively evaluated to date. Methods: We used a Japanese administrative database of 17,761 patients across 258 hospitals delivering both open gastrectomy and LG during 6-month periods in 2006, 2007, and 2008. We examined patient demographics, principal diagnosis, comorbidities, and complications, hospital patient volume, proportion of LG procedures accomplished, teaching status and care processes, length of hospital stay, total charge, and operative time. Multivariate analyses were used to compare LG with open gastrectomy in terms of mortality, complications, operative or postoperative blood transfusion, resource use and operative time. Results: LG was performed in 3,914 (22%) patients and was associated with significantly shorter length of hospital stay, lower total charge, and longer operative time. Higher hospital volume was associated with less mortality, lower frequency of transfusion, shorter length of hospital stay, lower total charge, and shorter operative time. Higher procedures accomplished were associated with fewer complications, higher frequency of transfusion, greater resource use, and longer operative time. Background: Laparoscopic gastrectomy offers significant economic advantages over open gastrectomy. However, LG was associated with increased operative time and required greater blood transfusion volume once indicated, which might drive gastrectomy care to use more prudent approaches in hospitals with higher procedures accomplished rates. Stakeholders should recognize the wide variation in hospital practices, skill training and efficient gastrectomy care, in addition to the volume-quality relationship.

元の言語English
ページ(範囲)64-70
ページ数7
ジャーナルAnnals of Surgery
253
発行部数1
DOI
出版物ステータスPublished - 2011 1
外部発表Yes

Fingerprint

Gastrectomy
Japan
Operative Time
Length of Stay
Blood Transfusion
High-Volume Hospitals
Mortality
Quality of Health Care
Blood Volume
Comorbidity
Teaching

ASJC Scopus subject areas

  • Surgery

これを引用

Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan. / Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B.; Horiguchi, Hiromasa; Fujimori, Kenji; Yasunaga, Hideo; Miyata, Hiroaki.

:: Annals of Surgery, 巻 253, 番号 1, 01.2011, p. 64-70.

研究成果: Article

Kuwabara, Kazuaki ; Matsuda, Shinya ; Fushimi, Kiyohide ; Ishikawa, Koichi B. ; Horiguchi, Hiromasa ; Fujimori, Kenji ; Yasunaga, Hideo ; Miyata, Hiroaki. / Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan. :: Annals of Surgery. 2011 ; 巻 253, 番号 1. pp. 64-70.
@article{6d724cdd4c56459b9cc8b26ee8111877,
title = "Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan",
abstract = "Objective: In this community-based study, we assessed the advantages of laparoscopic gastrectomy (LG) and the impact of volume-related hospital characteristics on gastrectomy care. Background: The quality of gastrectomy care and the potential effects of volume-related hospital characteristics on gastrectomy care have not been comprehensively evaluated to date. Methods: We used a Japanese administrative database of 17,761 patients across 258 hospitals delivering both open gastrectomy and LG during 6-month periods in 2006, 2007, and 2008. We examined patient demographics, principal diagnosis, comorbidities, and complications, hospital patient volume, proportion of LG procedures accomplished, teaching status and care processes, length of hospital stay, total charge, and operative time. Multivariate analyses were used to compare LG with open gastrectomy in terms of mortality, complications, operative or postoperative blood transfusion, resource use and operative time. Results: LG was performed in 3,914 (22{\%}) patients and was associated with significantly shorter length of hospital stay, lower total charge, and longer operative time. Higher hospital volume was associated with less mortality, lower frequency of transfusion, shorter length of hospital stay, lower total charge, and shorter operative time. Higher procedures accomplished were associated with fewer complications, higher frequency of transfusion, greater resource use, and longer operative time. Background: Laparoscopic gastrectomy offers significant economic advantages over open gastrectomy. However, LG was associated with increased operative time and required greater blood transfusion volume once indicated, which might drive gastrectomy care to use more prudent approaches in hospitals with higher procedures accomplished rates. Stakeholders should recognize the wide variation in hospital practices, skill training and efficient gastrectomy care, in addition to the volume-quality relationship.",
author = "Kazuaki Kuwabara and Shinya Matsuda and Kiyohide Fushimi and Ishikawa, {Koichi B.} and Hiromasa Horiguchi and Kenji Fujimori and Hideo Yasunaga and Hiroaki Miyata",
year = "2011",
month = "1",
doi = "10.1097/SLA.0b013e318204e524",
language = "English",
volume = "253",
pages = "64--70",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan

AU - Kuwabara, Kazuaki

AU - Matsuda, Shinya

AU - Fushimi, Kiyohide

AU - Ishikawa, Koichi B.

AU - Horiguchi, Hiromasa

AU - Fujimori, Kenji

AU - Yasunaga, Hideo

AU - Miyata, Hiroaki

PY - 2011/1

Y1 - 2011/1

N2 - Objective: In this community-based study, we assessed the advantages of laparoscopic gastrectomy (LG) and the impact of volume-related hospital characteristics on gastrectomy care. Background: The quality of gastrectomy care and the potential effects of volume-related hospital characteristics on gastrectomy care have not been comprehensively evaluated to date. Methods: We used a Japanese administrative database of 17,761 patients across 258 hospitals delivering both open gastrectomy and LG during 6-month periods in 2006, 2007, and 2008. We examined patient demographics, principal diagnosis, comorbidities, and complications, hospital patient volume, proportion of LG procedures accomplished, teaching status and care processes, length of hospital stay, total charge, and operative time. Multivariate analyses were used to compare LG with open gastrectomy in terms of mortality, complications, operative or postoperative blood transfusion, resource use and operative time. Results: LG was performed in 3,914 (22%) patients and was associated with significantly shorter length of hospital stay, lower total charge, and longer operative time. Higher hospital volume was associated with less mortality, lower frequency of transfusion, shorter length of hospital stay, lower total charge, and shorter operative time. Higher procedures accomplished were associated with fewer complications, higher frequency of transfusion, greater resource use, and longer operative time. Background: Laparoscopic gastrectomy offers significant economic advantages over open gastrectomy. However, LG was associated with increased operative time and required greater blood transfusion volume once indicated, which might drive gastrectomy care to use more prudent approaches in hospitals with higher procedures accomplished rates. Stakeholders should recognize the wide variation in hospital practices, skill training and efficient gastrectomy care, in addition to the volume-quality relationship.

AB - Objective: In this community-based study, we assessed the advantages of laparoscopic gastrectomy (LG) and the impact of volume-related hospital characteristics on gastrectomy care. Background: The quality of gastrectomy care and the potential effects of volume-related hospital characteristics on gastrectomy care have not been comprehensively evaluated to date. Methods: We used a Japanese administrative database of 17,761 patients across 258 hospitals delivering both open gastrectomy and LG during 6-month periods in 2006, 2007, and 2008. We examined patient demographics, principal diagnosis, comorbidities, and complications, hospital patient volume, proportion of LG procedures accomplished, teaching status and care processes, length of hospital stay, total charge, and operative time. Multivariate analyses were used to compare LG with open gastrectomy in terms of mortality, complications, operative or postoperative blood transfusion, resource use and operative time. Results: LG was performed in 3,914 (22%) patients and was associated with significantly shorter length of hospital stay, lower total charge, and longer operative time. Higher hospital volume was associated with less mortality, lower frequency of transfusion, shorter length of hospital stay, lower total charge, and shorter operative time. Higher procedures accomplished were associated with fewer complications, higher frequency of transfusion, greater resource use, and longer operative time. Background: Laparoscopic gastrectomy offers significant economic advantages over open gastrectomy. However, LG was associated with increased operative time and required greater blood transfusion volume once indicated, which might drive gastrectomy care to use more prudent approaches in hospitals with higher procedures accomplished rates. Stakeholders should recognize the wide variation in hospital practices, skill training and efficient gastrectomy care, in addition to the volume-quality relationship.

UR - http://www.scopus.com/inward/record.url?scp=78751632284&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78751632284&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e318204e524

DO - 10.1097/SLA.0b013e318204e524

M3 - Article

C2 - 21116173

AN - SCOPUS:78751632284

VL - 253

SP - 64

EP - 70

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 1

ER -