title: Hospital volume is not a predictor of outcomes after gastrectomy for neoplasm.
abstract: Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA. kreavis@uci.edu
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Marcelo W
authors.initials: MW
authors.lastname: Hinojosa
authors.forename: Brian R
authors.initials: BR
authors.lastname: Smith
authors.forename: James B
authors.initials: JB
authors.lastname: Wooldridge
authors.forename: Sindhu
authors.initials: S
authors.lastname: Krishnan
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States