Surgical specialty, surgical unit volume and mortality after oesophageal cancer surgery.
BACKGROUND
Mortality after oesophagectomy is lower in high-volume than in low-volume surgical units. Case series from cardiothoracic surgeons report lower mortality rates than those from general surgeons. We therefore used a national data set to investigate the effects of surgical specialty and volume on mortality after oesophagectomy.


METHODS
We analysed Hospital Episode Statistics for oesophagectomy for cancer (n=9034 cases), linked to data from death certificates, in England from 1998 to 2003.


RESULTS
After adjustment for patients' age, sex and deprivation score, the odds ratio (OR) for death of general surgeons' (GS) patients, compared with cardiothoracic surgeons' (CTS) patients, was significantly high: 1.62 [95% CI 1.34-1.96] at 30 days and 1.38 [1.18-1.61] at 90 days. The odds ratio for high-volume GS patients was not significantly different from that for high-volume CTS patients. However, the odds ratio for low-volume GS patients compared with high-volume CTS patients was significantly high: 1.72 (1.40-2.11) at 30 days and 1.48 (1.26-1.74) at 90 days.


CONCLUSIONS
Patients treated by general surgeons in low-volume hospitals had worse mortality outcomes than those treated by general surgeons in high-volume hospitals or by cardiothoracic surgeons. This is important because a majority of patients who underwent oesophagectomy for cancer were in this high-mortality risk group.
Leigh
Y
Y
Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK.
Goldacre
M
M
McCulloch
P
P
D004739:England; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013043:Specialties, Surgical / Q000706:statistics & numerical data*