Hospital volume and post-operative mortality after resection for gastric cancer.
OBJECTIVE
In low-volume hospitals, expertise in gastric surgery is difficult to maintain because of the decreasing incidence of gastric cancer and the fall of surgery for ulcer disease. We evaluated the prognostic impact of hospital volume on post-operative mortality (POM) in a consecutive series of 1978 patients.


METHODS
Information on patients undergoing resection for gastric cancer in the period 1987-97 was retrieved from the Rotterdam Cancer Registry. The relationship between hospital volume and POM was analysed by logistic regression, adjusting for other prognostic factors.


RESULTS
POM was 7.9% on average but varied between the 22 hospitals from 3.1% to 15.1% (P=0.15). Hospital volume had no prognostic influence (P=0.74). Prognostic factors were age (70-79 years odds ratio (OR)=3.8, 80+ years OR=6.0), sex (male OR=1.7), stage (IV OR=1.8) and (partial) gastrectomy for cardia cancers (OR=2.0).


CONCLUSIONS
Variation in POM between hospitals was large but not related to hospital volume. For cardia cancer, POM rates were lower after oesophagogastrectomy.
Damhuis
R A M
RA
Department of Cancer Registry and Research, Comprehensive Cancer Centre, Rotterdam, The Netherlands. canreg@ikr.nl
Meurs
C J C
CJ
Dijkhuis
C M
CM
Stassen
L P S
LP
Wiggers
T
T
D000328:Adult; D000367:Age Factors; D000368:Aged; D002983:Clinical Competence; D005260:Female; D005743:Gastrectomy / Q000401:mortality* / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014600:Utilization Review