title: Hospital volume and quality of laparoscopic gastrectomy in Japan.
abstract: BACKGROUND
  Laparoscopic gastrectomy (LG) has become the prevailing surgery of choice for gastric cancer, but the impact of hospital volume or operating room (OR) time has not been evaluated. An observational study was conducted to assess the quality of LG based on hospital volume and OR time.
  
  
  METHODS
  3,054 LG patients were enrolled in 420 hospitals throughout Japan. Analyzed variables included patient demographics, complications, use of stapling devices or chemotherapy, hospital volume, and teaching status. Hospitals were categorized into high- (>or=4 LG per month), intermediate- (1-3) and low- (<1) volume hospitals. Multivariate analysis was used to measure hospital volume and OR time impact.
  
  
  RESULTS
  259 laparoscopic total gastrectomies (LTGs) were performed. Complications were observed in 269 cases (8.8%). High-volume hospitals treated less severe cases. OR time, but not hospital volume, was associated with complications. Hospital volume, teaching status and stapling devices explained variations in OR time.
  
  
  CONCLUSIONS
  OR time was a more significant predictor of complications than hospital volume. OR time was consumed more in the employment of stapling devices and LTG. To promote LG efficiency, training curricula highlighting the applicability of these techniques should be considered by clinical experts.
authors.affiliation: Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan. kazu228 @ basil.ocn.ne.jp
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Koichi B
authors.initials: KB
authors.lastname: Ishikawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D008297:Male; D009873:Operating Rooms / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013274:Stomach Neoplasms / Q000601:surgery; D013997:Time Factors