Quantitative assessment of the advantages of laparoscopic gastrectomy and the impact of volume-related hospital characteristics on resource use and outcomes of gastrectomy patients in Japan.
OBJECTIVE
In this community-based study, we assessed the advantages of laparoscopic gastrectomy (LG) and the impact of volume-related hospital characteristics on gastrectomy care.


BACKGROUND
The quality of gastrectomy care and the potential effects of volume-related hospital characteristics on gastrectomy care have not been comprehensively evaluated to date.


METHODS
We used a Japanese administrative database of 17,761 patients across 258 hospitals delivering both open gastrectomy and LG during 6-month periods in 2006, 2007, and 2008. We examined patient demographics, principal diagnosis, comorbidities, and complications, hospital patient volume, proportion of LG procedures accomplished, teaching status and care processes, length of hospital stay, total charge, and operative time. Multivariate analyses were used to compare LG with open gastrectomy in terms of mortality, complications, operative or postoperative blood transfusion, resource use and operative time.


RESULTS
LG was performed in 3,914 (22%) patients and was associated with significantly shorter length of hospital stay, lower total charge, and longer operative time. Higher hospital volume was associated with less mortality, lower frequency of transfusion, shorter length of hospital stay, lower total charge, and shorter operative time. Higher procedures accomplished were associated with fewer complications, higher frequency of transfusion, greater resource use, and longer operative time.


CONCLUSIONS
Laparoscopic gastrectomy offers significant economic advantages over open gastrectomy. However, LG was associated with increased operative time and required greater blood transfusion volume once indicated, which might drive gastrectomy care to use more prudent approaches in hospitals with higher procedures accomplished rates. Stakeholders should recognize the wide variation in hospital practices, skill training and efficient gastrectomy care, in addition to the volume-quality relationship.
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan. kazu228@basil.ocn.ne.jp
Kazuaki
K
Kuwabara
Shinya
S
Matsuda
Kiyohide
K
Fushimi
Koichi B
KB
Ishikawa
Hiromasa
H
Horiguchi
Kenji
K
Fujimori
Hideo
H
Yasunaga
Hiroaki
H
Miyata
D000328:Adult; D000368:Aged; D005743:Gastrectomy; D006276:Health Facility Size; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome