Mortality rate associated with 56 consecutive esophagectomies performed at a "low-volume" hospital: is procedure volume as important as we are trying to make it?

BACKGROUND: Esophagectomy procedures have been associated with high morbidity and mortality rates. Recent articles in the literature have focused on the relationship between operative volume and the rates of mortality and morbidity in association with esophagectomy. The common theme among these publications is the statistically significant correlation between high-volume centers (typically defined as at least 10 esophagectomies per year) and lower mortality rates. The authors hypothesized that an individual surgeon's expertise with the various esophagectomy procedures would better correlate to mortality rates than the absolute number performed in an institution per year. STUDY
DESIGN: The study involved a retrospective cohort of a single surgeon over a 7-year period (August 17, 1999-December 23, 2006). Selection criteria included all patients who had undergone a transhiatal esophagectomy, transabdominal with diaphragmatic split esophagectomy, or Ivor-Lewis esophagectomy procedure by a single surgeon (PP) during the specified time period. The main outcome measures were 30-day mortality and postoperative complications.
RESULTS: Over the 7-year study period, 56 esophagectomies were performed (average, eight per year). The 30-day morbidity and mortality rates were 48% (27/56) and 3.57% (2/56), respectively.
CONCLUSIONS: If low-volume esophagectomy centers are to be defined in the literature as completing <10 procedures per year, then these data represent such an institution. While several authors have demonstrated a correlation between lower mortality rates and high-volume esophagectomy hospitals, our results support surgeon experience as potentially being more significant than absolute number of procedures performed in an institution per year.