title: Influence of a regional centralised upper gastrointestinal cancer service model on patient safety, quality of care and survival.
abstract: OBJECTIVE
  The aim of this study was to determine outcomes of a reconfigured centralised upper gastrointestinal (UGI) cancer service model, allied to an enhanced recovery programme, when compared with historical controls in a UK cancer network.
  
  
  METHODS
  Details of 606 consecutive patients diagnosed with UGI cancer were collected prospectively and outcomes before (n = 251) and after (n = 355) centralisation compared. Primary outcome measures were rates of curative treatment intent, operative morbidity, length of hospital stay and survival.
  
  
  RESULTS
  The rate of curative treatment intent increased from 21 to 36% after centralisation (P < 0.0001). Operative morbidity (mortality) and length of hospital stay before and after centralisation were 40% (2.5%) and 16 days, compared with 45% (2.4%) and 13 days, respectively (P = 0.024). The median and 1 year survival (all patients) improved from 8.7 months and 39.0% to 10.8 months and 46.8%, respectively, after centralisation (P = 0.032). On multivariate analysis, age (hazard ratio 1.894, 95% confidence interval 0.743-4.781, P < 0.0001), centralisation (hazard ratio 0.809, 95% confidence interval 0.668-0.979, P = 0.03) and overall radiological TNM stage (hazard ratio 3.905, 95% confidence interval 1.413-11.270, P < 0.0001) were independently associated with survival.
  
  
  CONCLUSIONS
  These outcomes confirm the patient safety, quality of care and survival improvements achievable by compliance with National Health Service Improving Outcomes Guidance.
authors.affiliation: Department of Surgery, South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK. Electronic address: dcsy23@gmail.com.
authors.forename: D S Y
authors.initials: DS
authors.lastname: Chan
authors.forename: T D
authors.initials: TD
authors.lastname: Reid
authors.forename: C
authors.initials: C
authors.lastname: White
authors.forename: A
authors.initials: A
authors.lastname: Willicombe
authors.forename: G
authors.initials: G
authors.lastname: Blackshaw
authors.forename: G W
authors.initials: GW
authors.lastname: Clark
authors.forename: T J
authors.initials: TJ
authors.lastname: Havard
authors.forename: X
authors.initials: X
authors.lastname: Escofet
authors.forename: T D L
authors.initials: TD
authors.lastname: Crosby
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002497:Centralized Hospital Services / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D061214:Patient Safety; D011787:Quality of Health Care; D013274:Stomach Neoplasms / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014852:Wales
keywords: Centralisation; gastric cancer; oesophageal cancer; surgery