OBJECTIVE: To determine the difference in in-hospital mortality and length of hospital stay (LOS) after esophagectomy between the United States and England. BACKGROUND: Since 2001, complex procedures such as esophagectomy have been centralized in England, but in the United States no formal plan for centralization exists. METHODS: Patients who underwent esophagectomy for cancer between 2005 and 2010 were identified from the Nationwide Inpatient Sample (United States) and the Hospital Episodes Statistics (England). In-hospital mortality and LOS were compared. RESULTS: There were 7433 esophagectomies performed in 66 English hospitals and 5858 resections in 775 US hospitals; median number of resections per center per year was 17.5 in England and 2 in the United States. In-hospital mortality was greater in US hospitals (5.50% vs 4.20%, P = 0.001). In multiple regression analysis, predictors of mortality included patient age, comorbidities, hospital volume, and surgery performed in the United States [odds ratio (OR) = 1.20 (1.02-1.41), P = 0.03]. Median LOS was greater in the English hospitals (15 vs 12 days, P < 0.001). However, when subset analysis was done on high-volume centers in both health systems, mortality was significantly better in US hospitals (2.10% vs 3.50%, P = 0.02). LOS was also seen to decrease in the US high-volume centers but not in England. CONCLUSIONS: The findings from this international comparison suggest that centralization of high-risk cancer surgery to centers of excellence with a high procedural volume translates into an improved clinical outcome. These findings should be factored into discussions regarding future service configuration of major cancer surgery in the United States.
OBJECTIVE: To determine the difference in in-hospital mortality and length of hospital stay (LOS) after esophagectomy between the United States and England. BACKGROUND: Since 2001, complex procedures such as esophagectomy have been centralized in England, but in the United States no formal plan for centralization exists. METHODS: Patients who underwent esophagectomy for cancer between 2005 and 2010 were identified from the Nationwide Inpatient Sample (United States) and the Hospital Episodes Statistics (England). In-hospital mortality and LOS were compared. RESULTS: There were 7433 esophagectomies performed in 66 English hospitals and 5858 resections in 775 US hospitals; median number of resections per center per year was 17.5 in England and 2 in the United States. In-hospital mortality was greater in US hospitals (5.50% vs 4.20%, P = 0.001). In multiple regression analysis, predictors of mortality included patient age, comorbidities, hospital volume, and surgery performed in the United States [odds ratio (OR) = 1.20 (1.02-1.41), P = 0.03]. Median LOS was greater in the English hospitals (15 vs 12 days, P < 0.001). However, when subset analysis was done on high-volume centers in both health systems, mortality was significantly better in US hospitals (2.10% vs 3.50%, P = 0.02). LOS was also seen to decrease in the US high-volume centers but not in England. CONCLUSIONS: The findings from this international comparison suggest that centralization of high-risk cancer surgery to centers of excellence with a high procedural volume translates into an improved clinical outcome. These findings should be factored into discussions regarding future service configuration of major cancer surgery in the United States.
Authors: Silvio Däster; Savas D Soysal; Luca Koechlin; Lea Stoll; Ralph Peterli; Markus von Flüe; Christoph Ackermann Journal: Langenbecks Arch Surg Date: 2016-07-19 Impact factor: 3.445
Authors: Emily Z Keung; Yi-Ju Chiang; Janice N Cormier; Keila E Torres; Kelly K Hunt; Barry W Feig; Christina L Roland Journal: Cancer Date: 2018-10-14 Impact factor: 6.860
Authors: Hans F Fuchs; Cristina R Harnsberger; Ryan C Broderick; David C Chang; Bryan J Sandler; Garth R Jacobsen; Michael Bouvet; Santiago Horgan Journal: Surg Endosc Date: 2016-09-22 Impact factor: 4.584