M Varagunam1, R Hardwick2, S Riley3, G Chadwick4, D A Cromwell5, O Groene6. 1. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK. Electronic address: m.varagunam@rcseng.ac.uk. 2. Cambridge Oesophago-Gastric Centre, Addenbrookes Hospital, Cambridge, UK. 3. Department of Gastroenterology, Northern General Hospital, Sheffield, UK. 4. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK. 5. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. 6. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; OptiMedis AG, Burchardstraße 17, 20095, Hamburg, Germany.
Abstract
AIM: The centralisation of oesophago-gastric (O-G) cancer services in England was recommended in 2001, partly because of evidence for a volume-outcome effect for patients having surgery. This study investigated the changes in surgical services for O-G cancer and postoperative mortality since centralisation. METHODS: Patients with O-G cancer who had an oesophageal or gastric resection between April 2003 and March 2014 were identified in the national Hospital Episodes Statistics database. We derived information on the number of NHS trusts performing surgery, their surgical volume, and the number of consultants operating. Postoperative mortality was measured at 30 days, 90 days and 1 year. Logistic regression was used to examine how surgical outcomes were related to patient characteristics and organisational variables. RESULTS: During this period, 29 205 patients underwent an oesophagectomy or gastrectomy. The number of NHS trusts performing surgery decreased from 113 in 2003-04 to 43 in 2013-14, and the median annual surgical volume in NHS trusts rose from 21 to 55 patients. The annual 30 day, 90 day and 1 year mortality decreased from 7.4%, 11.3% and 29.7% in 2003-04 to 2.5%, 4.6% and 19.8% in 2013-14, respectively. There was no evidence that high-risk patients were not undergoing surgery. Changes in NHS trust volume explained only a small proportion of the observed fall in mortality. CONCLUSION: Centralisation of surgical services for O-G cancer in England has resulted in lower postoperative mortality. This cannot be explained by increased volume alone.
AIM: The centralisation of oesophago-gastric (O-G) cancer services in England was recommended in 2001, partly because of evidence for a volume-outcome effect for patients having surgery. This study investigated the changes in surgical services for O-G cancer and postoperative mortality since centralisation. METHODS:Patients with O-G cancer who had an oesophageal or gastric resection between April 2003 and March 2014 were identified in the national Hospital Episodes Statistics database. We derived information on the number of NHS trusts performing surgery, their surgical volume, and the number of consultants operating. Postoperative mortality was measured at 30 days, 90 days and 1 year. Logistic regression was used to examine how surgical outcomes were related to patient characteristics and organisational variables. RESULTS: During this period, 29 205 patients underwent an oesophagectomy or gastrectomy. The number of NHS trusts performing surgery decreased from 113 in 2003-04 to 43 in 2013-14, and the median annual surgical volume in NHS trusts rose from 21 to 55 patients. The annual 30 day, 90 day and 1 year mortality decreased from 7.4%, 11.3% and 29.7% in 2003-04 to 2.5%, 4.6% and 19.8% in 2013-14, respectively. There was no evidence that high-risk patients were not undergoing surgery. Changes in NHS trust volume explained only a small proportion of the observed fall in mortality. CONCLUSION: Centralisation of surgical services for O-G cancer in England has resulted in lower postoperative mortality. This cannot be explained by increased volume alone.
Authors: Vasileios Charalampakis; Victor Roth Cardoso; Rajwinder Nijjar; Rishi Singhal; Alistair Sharples; Maha Khalid; Luke Dickerson; Tom Wiggins; Georgios V Gkoutos; Olga Tucker; Paul Super; Martin Richardson Journal: Surg Endosc Date: 2022-10-07 Impact factor: 3.453
Authors: Willemieke P M Dijksterhuis; Rob H A Verhoeven; Sybren L Meijer; Marije Slingerland; Nadia Haj Mohammad; Judith de Vos-Geelen; Laurens V Beerepoot; Theo van Voorthuizen; Geert-Jan Creemers; Martijn G H van Oijen; Hanneke W M van Laarhoven Journal: Gastric Cancer Date: 2020-01-11 Impact factor: 7.370
Authors: L Siragusa; B Sensi; D Vinci; M Franceschilli; C Pathirannehalage Don; G Bagaglini; V Bellato; M Campanelli; G S Sica Journal: Discov Oncol Date: 2021-04-12