Association of surgeon and hospital volume with postoperative mortality after total gastrectomy for gastric cancer: data
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ORIGINAL ARTICLE
Association of surgeon and hospital volume with postoperative mortality after total gastrectomy for gastric cancer: data from 71,307 Japanese patients collected from a nationwide web‑based data entry system Masaaki Iwatsuki1 · Hiroyuki Yamamoto2,3 · Hiroaki Miyata2,3 · Yoshihiro Kakeji4 · Kazuhiro Yoshida5 · Hiroyuki Konno6 · Yasuyuki Seto7 · Hideo Baba1 Received: 22 July 2020 / Accepted: 22 September 2020 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2020
Abstract 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. Keywords Gastric cancer · Total gastrectomy · Surgeon volume · Hospital volume
Introduction Gastric cancer is one of the most common cancers and is associated with a high mortality rate worldwide [1]. The prognosis of patients with advanced gastric cancer remains * Hideo Baba hdobaba@kumamoto‑u.ac.jp 1
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Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1‑1‑1 Honjo, Chuo‑ku, Kumamoto 860‑8556, Japan Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
poor despite of the recent progress in cancer treatment. Gastrectomy with regional lymph node dissection is the most effective treatment for gastric cancer. For advanced gastric cancer, gastrectomy with D2 lymph node dis
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