BACKGROUND: A relationship between hospital procedural volume and patient outcomes has been observed in gastrectomies for primary gastric cancer, but modifiable factors influencing this relationship are not well elaborated. METHODS: We performed a population-based study of 1864 patients undergoing gastrectomy for primary gastric cancers at 214 hospitals. Hospitals were stratified as high-, intermediate-, or low-volume centers. Multivariate models were constructed to evaluate the effect of institutional procedural volume and other hospital- and patient-specific factors on the risk of in-hospital mortality, adverse events, and failure to rescue, defined as mortality after an adverse event. RESULTS: High-volume centers attained an in-hospital mortality rate of 1.0% and failure-to-rescue rate of .7%, both less than one-fifth of that seen at intermediate- and low-volume centers, although adverse event rates were similar across the three volume tiers. In multivariate modeling, treatment at a high-volume hospital decreased the odds of mortality (odds ratio [OR], .22; 95% confidence interval [95% CI], .05-.89), whereas treatment at an institution with a high ratio of licensed vocational nurses per bed increased the odds of mortality (OR, 1.96; 95% CI, 1.04-3.75). Being treated at a hospital with a greater than median number of critical care beds decreased odds of mortality (OR, .46; 95% CI, .25-.81) and failure to rescue (OR, .53; 95% CI, .29-.97). CONCLUSIONS: Undergoing gastrectomy at a high-volume center is associated with lower in-hospital mortality. However, improving the rates of mortality after adverse events and reevaluating nurse staffing ratios may provide avenues by which lower-volume centers can improve mortality rates.
BACKGROUND: A relationship between hospital procedural volume and patient outcomes has been observed in gastrectomies for primary gastric cancer, but modifiable factors influencing this relationship are not well elaborated. METHODS: We performed a population-based study of 1864 patients undergoing gastrectomy for primary gastric cancers at 214 hospitals. Hospitals were stratified as high-, intermediate-, or low-volume centers. Multivariate models were constructed to evaluate the effect of institutional procedural volume and other hospital- and patient-specific factors on the risk of in-hospital mortality, adverse events, and failure to rescue, defined as mortality after an adverse event. RESULTS: High-volume centers attained an in-hospital mortality rate of 1.0% and failure-to-rescue rate of .7%, both less than one-fifth of that seen at intermediate- and low-volume centers, although adverse event rates were similar across the three volume tiers. In multivariate modeling, treatment at a high-volume hospital decreased the odds of mortality (odds ratio [OR], .22; 95% confidence interval [95% CI], .05-.89), whereas treatment at an institution with a high ratio of licensed vocational nurses per bed increased the odds of mortality (OR, 1.96; 95% CI, 1.04-3.75). Being treated at a hospital with a greater than median number of critical care beds decreased odds of mortality (OR, .46; 95% CI, .25-.81) and failure to rescue (OR, .53; 95% CI, .29-.97). CONCLUSIONS: Undergoing gastrectomy at a high-volume center is associated with lower in-hospital mortality. However, improving the rates of mortality after adverse events and reevaluating nurse staffing ratios may provide avenues by which lower-volume centers can improve mortality rates.
Authors: Mashaal Dhir; Lynette M Smith; Fred Ullrich; Premila D Leiphrakpam; Quan P Ly; Aaron R Sasson; Chandrakanth Are Journal: J Gastrointest Surg Date: 2012-09-05 Impact factor: 3.452
Authors: Giuseppe Verlato; Simone Giacopuzzi; Maria Bencivenga; Paolo Morgagni; Giovanni De Manzoni Journal: World J Gastroenterol Date: 2014-09-28 Impact factor: 5.742
Authors: Iain G Thomson; David C Gotley; Andrew P Barbour; Ian Martin; Neil Jayasuria; Janine Thomas; Bernard M Smithers Journal: Gastric Cancer Date: 2013-03-09 Impact factor: 7.370
Authors: Reese W Randle; Douglas S Swords; Edward A Levine; Nora F Fino; Malcolm H Squires; George Poultsides; Ryan C Fields; Mark Bloomston; Sharon M Weber; Timothy M Pawlik; Linda X Jin; Gaya Spolverato; Carl Schmidt; David Worhunsky; Clifford S Cho; Shishir K Maithel; Konstantinos I Votanopoulos Journal: J Surg Oncol Date: 2016-03-21 Impact factor: 3.454