The Academic Facility Is Associated with Higher Utilization of Esophagectomy and Improved Overall Survival for Esophagea
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ORIGINAL ARTICLE
The Academic Facility Is Associated with Higher Utilization of Esophagectomy and Improved Overall Survival for Esophageal Carcinoma Robert E. Merritt, MD 1 Peter J. Kneuertz, MD 1
&
Mahmoud Abdel-Rasoul, MPH 2 & Morgan Fitzgerald, MPH 1 & Desmond M. D’Souza, MD 1 &
Received: 28 June 2020 / Accepted: 30 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Operable esophageal carcinoma is potentially curable with surgical resection. The short-term outcomes and overall survival rate for operable esophageal carcinoma may be impacted by the healthcare facility type where patients receive care. Methods A total of 37, 271 cases with the American Joint Committee on Cancer clinical stage I, II, and III esophageal carcinoma that were reported to the National Cancer Data Base at over 12,721 facilities were analyzed. Healthcare facilities were dichotomized into the community and academic facility types. Marginal multivariable Cox proportional hazard models were used to evaluate differences in overall survival between facility types, which accounted for facility esophageal cancer volume. Propensity score methodology with inverse probability of treatment weighting was used to adjust for patient related baseline differences between facility types. Results Patients with clinical stage I–III esophageal carcinoma who underwent esophagectomy at academic healthcare facilities had a significantly better overall survival compared with patients who underwent esophagectomy at community healthcare facilities [HR = 0.89: CI [0.84–0.95] (p = 0.0005)]. The rate of esophagectomy was significantly higher at the academic facilities (49.0% versus 26.5%; p < 0.0001). The 30-day and 90-day mortality rates for esophagectomy were significantly better for patients who underwent esophagectomy for esophageal cancer at the academic facility types. Conclusion Patients with clinical stage I–III esophageal carcinoma who received care at academic facility types had significantly better overall survival compared with community facility types. The utilization of esophagectomy was significantly higher and the short-term surgical outcomes were better for patients treated at academic facility types. Keywords Esophagectomy . Esophageal cancer . Overall survival
Introduction Esophageal carcinoma accounts for over 17,000 new cases a year in the USA.1 It is the sixth leading cause of cancer-related death in the world.2 Early-stage esophageal carcinoma (clinical stage I) is typically treated with esophagectomy and lymph * Robert E. Merritt, MD [email protected] 1
Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Doan Hall N847, 410 West 10th Avenue, Columbus, OH 43210, USA
2
Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
node dissection which gives patients the best chance for longterm survival.2 Locally advanced esophageal carcinoma (clinical stage II–III) is usually treated with neoadjuvan
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