Organisation and early outcomes of major upper gastrointestinal cancer surgery in Denmark 1996-2004.
BACKGROUND
To assess the relationship between hospital volume and early postoperative outcome the incidence and early outcome of all esophagectomies, pancreaticoduodenectomies and gastric resections in Denmark from 1996 to 2004 was described.


METHODS
The National Patient Registry and discharge information from all hospital departments were analysed for all the operations due to a malignant diagnosis. All information was examined for postoperative length of stay and hospital mortality.


RESULTS
During the study period 26 departments performed at least one esophageal resection, 13 departments performed at least one Whipple procedure and 37 departments performed at least one gastric resection. Four departments performed more than 20 esophageal resections per year, whereas one department performed more than 20 Whipple procedures and one more than 20 gastric resections per year. The overall mean length of stay was 21.6 days, 24 days and 18 days for esophageal, pancreatic and gastric resections, respectively, with no difference between high and low volume departments. The hospital mortality was 8.6%, 8.9% and 8.2%, respectively.


CONCLUSIONS
The overall high mortality and long postoperative stay in patients undergoing upper gastrointestinal cancer surgery in Denmark calls for improvement by regionalisation into 3-4 departments and monitoring of results.
Jensen
L S
LS
Department of Surgery L, Aarhus Sygehus, Aarhus, Denmark. lsjen@as.aaa.dk
Bendixen
A
A
Kehlet
H
H
D003718:Denmark / Q000453:epidemiology; D016629:Esophagectomy; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D013502:General Surgery / Q000458:organization & administration*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016577:Pancreaticoduodenectomy; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies