title: Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment.
abstract: OBJECTIVE
  We investigated the risk factors for early postoperative complications after gastric cancer surgery.
  
  
  METHODS
  The data from a total of 273 patients with gastric cancer were analyzed by univariate and multivariate analysis. We applied physiological and operative severity score for the enumeration of morbidity and mortality (POSSUM) to compare risk-adjusted surgical outcomes among different surgical units.
  
  
  RESULTS
  Among the preoperative variables, patient gender, chronic obstructive pulmonary disease, surgical unit, and intraoperative blood loss were independent risk factors for a higher rate of postoperative complications. There were significant differences in complication rates among different surgical units (P = 0.001). The observed-to-expected morbidity ratio (O-to-E ratio) ranged from 0.81 to 1.63. Units with low surgical work volume had higher complication rates. Postoperative length of stay was significantly shorter (P = 0.000) and the rate of moderate and severe complications was significantly lower (P = 0.001) in specialized unit.
  
  
  CONCLUSIONS
  POSSUM is a valid system for risk-adjusted evaluation of surgical outcomes. We conclude that surgical experience and work volume greatly influence the outcome, with overall surgical outcome in specialized centers superior to that in other units. Hence, gastric cancer surgery should be performed in specialized centers. Risk factors identified in this study need further confirmation by a prospective study involving a larger cohort.
authors.affiliation: Department of General Surgery, Rui Jin Hospital, 197 Rui Jin Er Road, Shanghai, 200025, China.
authors.forename: Birendra Kumar
authors.initials: BK
authors.lastname: Sah
authors.forename: Zheng Gang
authors.initials: ZG
authors.lastname: Zhu
authors.forename: Ming Min
authors.initials: MM
authors.lastname: Chen
authors.forename: Ming
authors.initials: M
authors.lastname: Xiang
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Min
authors.initials: M
authors.lastname: Yan
authors.forename: Yan Zhen
authors.initials: YZ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002681:China; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology; D020379:Risk Adjustment; D012307:Risk Factors; D012720:Severity of Illness Index; D013038:Specialization / Q000706:statistics & numerical data; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult