title: Mortality after esophageal and gastric cancer resection.
abstract: BACKGROUND
  Contrasting findings on trends and determinants of operative mortality after surgery for esophageal and gastric cancer have been reported from population-based studies.
  
  
  METHODS
  Discharge records of residents in the Veneto Region (northeastern Italy) with a diagnosis of esophageal or gastric cancer and intervention codes for esophagectomy or gastrectomy were extracted for the years 2000-2009. In-hospital, 30-day, 90-day, and perioperative (30-day + in-hospital) mortality were computed. The influence of patient and hospital variables on in-hospital mortality was assessed through multilevel models.
  
  
  RESULTS
  Overall, 6,500 resections were performed in the period of 2000-2009, with a 10 % decline in the second half of the study period. In-hospital mortality was 4.6 % (5.3 % in 2000-2004 and 3.8 % in 2005-2009) and was higher for extended total gastrectomy and total esophagectomy. In 2005-2009 mortality declined for all resection types except extended total gastrectomy (8.0 %). For esophageal procedures, 30-day mortality was lower than in-hospital or perioperative mortality. A protective effect of procedural volume was found for esophageal but not for gastric resections; among gastric procedures, mortality was higher in male patients and in extended total gastrectomy patients.
  
  
  CONCLUSIONS
  Analyses of discharge records allowed investigation at a population level of time trends (downward mainly for esophageal resections) and determinants of perioperative mortality (hospital volume, gender, and procedure type).
authors.affiliation: SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131 Padova, Italy. ugo.fedeli@regione.veneto.it
authors.forename: Ugo
authors.initials: U
authors.lastname: Fedeli
authors.forename: Elena
authors.initials: E
authors.lastname: Schievano
authors.forename: Manola
authors.initials: M
authors.lastname: Lisiero
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*