title: Relationship between volume and in-hospital mortality in digestive oncological surgery.
abstract: BACKGROUND
  The results previously obtained in Spain in the study of the relationship between surgical caseload and in-hospital mortality are inconclusive. The aim of this study is to evaluate the volume-outcome association in Spain in the setting of digestive oncological surgery.
  
  
  METHODS
  An analytical, cross-sectional study was conducted with data from patients who underwent surgical procedures with curative intent of esophageal, gastric, colorectal and pancreatic neoplasms between 2006-2009 with data from the Spanish MBDS. In-hospital mortality was used as outcome variable. Control variables were patient, health care and hospital characteristics. Exposure variable was the number of interventions for each disease, dividing the hospitals in 3 categories: high volume (HV), mid volume (MV) and low volume (LV) according to the number of procedures.
  
  
  RESULTS
  An inverse, statistically significant relationship between procedure volume and in-hospital mortality was observed for both volume categories in both gastric (LV: OR=1,50 [IC 95%: 1,28-1,76]; MV: OR=1,49 (IC 95%: 1,28-1,74)) and colorectal (LV: OR=1,44 [IC 95%: 1,33-1,55]; MV: OR=1,24 [IC 95%: 1,15-1,33]) cancer surgery. In pancreatic procedures, this difference was only statistically significant between LV and HV categories (LV: OR=1,89 [IC 95%: 1,29-2,75]; MV: OR=1,21 [IC 95%: 0,82-1,79]). Esophageal surgery also showed an inverse relationship, which was not statistically significant (LV: OR=1,89 [IC 95%: 0,98-3,64]; MV: OR=1,05 [IC 95%: 0,50-2,21]).
  
  
  CONCLUSIONS
  The results of this study suggest the existence in Spain of an inverse relationship between caseload and in-hospital mortality in digestive oncological surgery for the procedures analyzed.
authors.affiliation: Unidad Docente de Cirugía, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
authors.forename: Paloma
authors.initials: P
authors.lastname: Pérez-López
authors.affiliation: Epidemiología Clínica y Cribado de Cáncer, Parc Taulí Sabadell-Universitat Autònoma de Barcelona (UAB), Barcelona, España; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC).
authors.forename: Marisa
authors.initials: M
authors.lastname: Baré
authors.affiliation: Servicio de Anestesiología, Hospital Morales Meseguer, Murcia, España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Touma-Fernández
authors.affiliation: Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC); Unidad Docente de Salud Pública, Medicina Legal e Historia de la Ciencia, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, España; Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España. Electronic address: asarria@isciii.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sarría-Santamera
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures; D005770:Gastrointestinal Neoplasms; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D017063:Outcome Assessment, Health Care; D012004:Rectal Neoplasms; D012189:Retrospective Studies; D018426:SEER Program; D013030:Spain; D015996:Survival Rate
keywords: Cirugía gastrointestinal; Colorectal cancer; Cáncer colorrectal; Cáncer de estómago; Cáncer de esófago; Cáncer de páncreas; Esophageal cancer; Gastric cancer; Gastrointestinal surgery; High-volume hospitals; Hospitales de volumen bajo de casos; Hospitales de volumen elevado de casos; In-hospital mortality; Low-volume hospitals; Mortalidad hospitalaria; Pancreatic cancer