title: Influence of hospital type on outcomes after oesophageal and gastric cancer surgery.
abstract: BACKGROUND
  Outcomes after oesophagectomy and gastrectomy vary considerably between hospitals. Possible explanations include differences in case mix, hospital volume and hospital type. The present study examined the distribution of oesophagectomies and gastrectomies between hospital types in the Netherlands, and the relationship between hospital type and outcome.
  
  
  METHODS
  Data were obtained from the nationwide Netherlands Cancer Registry. Hospitals were categorized as university hospitals (UH), non-university teaching hospitals (NUTH) and non-university non-teaching hospitals (NUNTH). Hospital type-outcome relationships were analysed by Cox regression, adjusting for case mix, hospital volume, year of diagnosis and use of multimodal therapies.
  
  
  RESULTS
  Between 1989 and 2009, 10 025 oesophagectomies and 14 221 gastrectomies for cancer were performed in the Netherlands. The percentage of oesophagectomies and gastrectomies performed in UH increased from 17·6 and 6·4 per cent respectively in 1989 to 44·1 and 12·9 per cent in 2009. After oesophagectomy, the 3-month mortality rate was 2·5 per cent in UH, 4·4 per cent in NUTH and 4·1 per cent in NUNTH (P = 0·006 for UH versus NUTH). After gastrectomy, the 3-month mortality rate was 4·9 per cent in UH, 8·9 per cent in NUTH and 8·7 per cent in NUNTH (P < 0·001 for UH versus NUTH). Three-year survival was also higher in UH than in NUTH and NUNTH.
  
  
  CONCLUSIONS
  Oesophagogastric resections performed in UH were associated with better outcomes but, owing to variation in outcomes within hospital types, centres of excellence cannot be designated solely on hospital type. Detailed information on case mix and outcomes is needed to identify centres of excellence.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Dikken
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: V E P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: H
authors.initials: H
authors.lastname: Putter
authors.forename: L G M
authors.initials: LG
authors.lastname: van der Geest
authors.forename: M
authors.initials: M
authors.lastname: Verheij
authors.forename: A
authors.initials: A
authors.lastname: Cats
authors.forename: J W
authors.initials: JW
authors.lastname: van Sandick
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000401:mortality* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012959:Socioeconomic Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome