Effects of hospital and surgeon case-volumes on postoperative complications and length of stay after esophagectomy in Japan.
OBJECTIVE
The exact relationship between larger caseload volume and lower morbidity following esophagectomy has not been established. This study investigates the effect of surgical volumes on reducing postoperative complications and length of stay after esophagectomy.


METHODS
Patient and hospital data were collected electronically via a web-based questionnaire sent to surgeons in the Japan Surgical Society. Data were based on 642 patients treated with esophagectomy at 183 hospitals between November 1, 2006 and February 28, 2007. Multivariate analysis revealed that postoperative morbidity and length of stay regressed against hospital and surgeon volumes, patient characteristics, and details of the procedures.


RESULTS
In a logistic regression model, esophagectomies by surgeons performing a high volume of operations (>100 cases; "high case-volume surgeons") were followed by a significantly lower rate of postoperative complications (odds ratio [OR], 0.49; 95% confidence interval (CI), 0.24-0.98, P = 0.04). In a proportional hazard model, high-volume surgeons reduced the length of stay significantly: the hazard ratio for medium casevolume surgeons (50-99 cases) was 1.53 [95% CI, 1.14-2.06, P = 0.00], whereas that for the highest case-volume surgeons was 1.34 [95% CI, 1.00-1.79, P = 0.05] vs the lowest case-volume surgeons. Neither postoperative complications nor length of stay were significantly associated with hospital volume.


CONCLUSIONS
These findings indicate that morbidity after esophagectomy is more dependent on individual surgeon-specific skill than on hospital-based factors.
Yasunaga
Hideo
H
Department of Health Management and Policy, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Matsuyama
Yutaka
Y
Ohe
Kazuhiko
K
D000368:Aged; D016629:Esophagectomy / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data