Y Leigh1, M Goldacre, P McCulloch. 1. Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK.
Abstract
BACKGROUND: Mortality after oesophagectomy is lower in high-volume than in low-volume surgical units. Case series from cardiothoracic surgeons report lower mortality rates than those from general surgeons. We therefore used a national data set to investigate the effects of surgical specialty and volume on mortality after oesophagectomy. METHODS: We analysed Hospital Episode Statistics for oesophagectomy for cancer (n=9034 cases), linked to data from death certificates, in England from 1998 to 2003. RESULTS: After adjustment for patients' age, sex and deprivation score, the odds ratio (OR) for death of general surgeons' (GS) patients, compared with cardiothoracic surgeons' (CTS) patients, was significantly high: 1.62 [95% CI 1.34-1.96] at 30 days and 1.38 [1.18-1.61] at 90 days. The odds ratio for high-volume GS patients was not significantly different from that for high-volume CTS patients. However, the odds ratio for low-volume GS patients compared with high-volume CTS patients was significantly high: 1.72 (1.40-2.11) at 30 days and 1.48 (1.26-1.74) at 90 days. CONCLUSION: Patients treated by general surgeons in low-volume hospitals had worse mortality outcomes than those treated by general surgeons in high-volume hospitals or by cardiothoracic surgeons. This is important because a majority of patients who underwent oesophagectomy for cancer were in this high-mortality risk group.
BACKGROUND: Mortality after oesophagectomy is lower in high-volume than in low-volume surgical units. Case series from cardiothoracic surgeons report lower mortality rates than those from general surgeons. We therefore used a national data set to investigate the effects of surgical specialty and volume on mortality after oesophagectomy. METHODS: We analysed Hospital Episode Statistics for oesophagectomy for cancer (n=9034 cases), linked to data from death certificates, in England from 1998 to 2003. RESULTS: After adjustment for patients' age, sex and deprivation score, the odds ratio (OR) for death of general surgeons' (GS) patients, compared with cardiothoracic surgeons' (CTS) patients, was significantly high: 1.62 [95% CI 1.34-1.96] at 30 days and 1.38 [1.18-1.61] at 90 days. The odds ratio for high-volume GSpatients was not significantly different from that for high-volume CTSpatients. However, the odds ratio for low-volume GSpatients compared with high-volume CTSpatients was significantly high: 1.72 (1.40-2.11) at 30 days and 1.48 (1.26-1.74) at 90 days. CONCLUSION:Patients treated by general surgeons in low-volume hospitals had worse mortality outcomes than those treated by general surgeons in high-volume hospitals or by cardiothoracic surgeons. This is important because a majority of patients who underwent oesophagectomy for cancer were in this high-mortality risk group.
Authors: Geoffrey Paul Kohn; Joseph Anton Galanko; Michael Owen Meyers; Richard Harry Feins; Timothy Michael Farrell Journal: J Gastrointest Surg Date: 2009-09-16 Impact factor: 3.452
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