Assessment of hospital characteristics associated with improved mortality following complex upper gastrointestinal cancer surgery in Queensland.
Aged
Aged, 80 and over
Case-Control Studies
Esophagectomy
/ mortality
Female
Gastrointestinal Neoplasms
/ surgery
Hospital Mortality
/ trends
Hospitals, High-Volume
/ statistics & numerical data
Hospitals, Low-Volume
/ statistics & numerical data
Humans
Male
Middle Aged
Pancreaticoduodenectomy
/ mortality
Queensland
/ epidemiology
Social Class
Specialties, Surgical
/ statistics & numerical data
Surgical Procedures, Operative
/ adverse effects
high-volume hospitals
hospital mortality
low-volume hospitals
oesophagectomy
pancreaticoduodenectomy
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
05
06
2019
revised:
01
07
2019
accepted:
05
07
2019
pubmed:
4
9
2019
medline:
2
10
2020
entrez:
4
9
2019
Statut:
ppublish
Résumé
High hospital-volume and service capability are associated with improved mortality following complex cancer surgery. Using a population-based study in Queensland, we assessed differences in mortality following oesophagectomy and pancreaticoduodenectomy, comparing high- and low-volume hospitals stratified by service capability. Data on all patients undergoing oesophagectomy and pancreaticoduodenectomy for cancer in Queensland between 2001 and 2015 were obtained from the Queensland Oncology Repository. Hospital service capability was defined using the 2015 Australian Institute of Health and Welfare hospital peer groupings. Hospitals were grouped into 'high-volume (≥6 oesophagectomies or pancreaticoduodenectomies annually) with high service capability'; 'low-volume (<6) with high service capability' and 'low-volume with low service capability'. Multivariate Poisson models were used to estimate differences in 30- and 90-day mortality between hospital groups adjusting for age, sex, socioeconomic status, Charlson and American Society of Anesthesiologists scores, chemotherapy, radiotherapy, stage and time-period. For oesophagectomy, adjusted 90-day mortality was higher in low-volume compared with high-volume hospitals, regardless of service capability (low-volume, high service: incident rate ratio (IRR) 3.86, 95% confidence interval (CI) 1.74-8.57; low-volume, low service: IRR 3.40, 95% CI 1.16-10.00). For pancreaticoduodenectomy, mortality was higher in low-volume compared with high-volume centres regardless of service capability: 30-day mortality (low-volume, high service: IRR 2.32, 95% CI 1.07-5.03; low-volume, low service: IRR 3.92, 95% CI 1.45-10.61); 90-day mortality (low-volume, high service: IRR 2.36, 95% CI 1.29-4.30; low-volume, low service: IRR 3.32, 95% CI 1.64-6.71). High hospital resection volumes are associated with lower post-operative mortality following oesophagectomy and pancreaticoduodenectomy regardless of hospital service capability. This data supports centralization of these procedures to high-volume centres.
Sections du résumé
BACKGROUND
High hospital-volume and service capability are associated with improved mortality following complex cancer surgery. Using a population-based study in Queensland, we assessed differences in mortality following oesophagectomy and pancreaticoduodenectomy, comparing high- and low-volume hospitals stratified by service capability.
METHODS
Data on all patients undergoing oesophagectomy and pancreaticoduodenectomy for cancer in Queensland between 2001 and 2015 were obtained from the Queensland Oncology Repository. Hospital service capability was defined using the 2015 Australian Institute of Health and Welfare hospital peer groupings. Hospitals were grouped into 'high-volume (≥6 oesophagectomies or pancreaticoduodenectomies annually) with high service capability'; 'low-volume (<6) with high service capability' and 'low-volume with low service capability'. Multivariate Poisson models were used to estimate differences in 30- and 90-day mortality between hospital groups adjusting for age, sex, socioeconomic status, Charlson and American Society of Anesthesiologists scores, chemotherapy, radiotherapy, stage and time-period.
RESULTS
For oesophagectomy, adjusted 90-day mortality was higher in low-volume compared with high-volume hospitals, regardless of service capability (low-volume, high service: incident rate ratio (IRR) 3.86, 95% confidence interval (CI) 1.74-8.57; low-volume, low service: IRR 3.40, 95% CI 1.16-10.00). For pancreaticoduodenectomy, mortality was higher in low-volume compared with high-volume centres regardless of service capability: 30-day mortality (low-volume, high service: IRR 2.32, 95% CI 1.07-5.03; low-volume, low service: IRR 3.92, 95% CI 1.45-10.61); 90-day mortality (low-volume, high service: IRR 2.36, 95% CI 1.29-4.30; low-volume, low service: IRR 3.32, 95% CI 1.64-6.71).
CONCLUSION
High hospital resection volumes are associated with lower post-operative mortality following oesophagectomy and pancreaticoduodenectomy regardless of hospital service capability. This data supports centralization of these procedures to high-volume centres.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1404-1409Subventions
Organisme : Metro South Health
ID : PARSS_2018_022
Pays : International
Informations de copyright
© 2019 Royal Australasian College of Surgeons.
Références
Ervik M, Ferlay J, Mery L, Soerjomataram I, Bray F. Cancer Today. Lyon, France: International Agency for Research on Cancer, 2016. [Cited 30 Jun 2019.] Available from URL: http://gco.iarc.fr/today
Law S. Esophagectomy without mortality: what can surgeons do? J. Gastrointest. Surg. 2010; 14(Suppl. 1): S101-7.
Stavrou EP, Smith GS, Baker DF. Surgical outcomes associated with oesophagectomy in New South Wales: an investigation of hospital volume. J. Gastrointest. Surg. 2010; 14: 951-7.
Smith RC, Creighton N, Lord RV et al. Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001-2008. Med. J. Aust. 2014; 200: 408-13.
Markar S, Gronnier C, Duhamel A et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: results from a large European multicenter study. Ann. Surg. Oncol. 2015; 22: 2615-23.
Soreide JA, Sandvik OM, Soreide K. Improving pancreas surgery over time: performance factors related to transition of care and patient volume. Int. J. Surg. 2016; 32: 116-22.
Mamidanna R, Ni Z, Anderson O et al. Surgeon volume and cancer esophagectomy, gastrectomy, and pancreatectomy: a population-based study in England. Ann. Surg. 2016; 263: 727-32.
Hore T, Thomas M, Brown L, Sakowska M, Connor S. Is there an alternative to centralization for pancreatic resection in New Zealand? ANZ J. Surg. 2016; 86: 332-6.
Alemanno G, Bergamini C, Martellucci J et al. Surgical outcome of pancreaticoduodenectomy: high volume center or multidisciplinary management? Minerva Chir 2016; 71: 8-14.
Lauder CI, Marlow NE, Maddern GJ et al. Systematic review of the impact of volume of oesophagectomy on patient outcome. ANZ J. Surg. 2010; 80: 317-23.
Markar S, Karthikesalingam A, Thrumurthy S, Low D. Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000-2011. J. Gastrointest. Surg. 2012; 16: 1055-63.
van der Geest LG, van Rijssen LB, Molenaar IQ et al. Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB 2016; 18: 317-24.
Gooiker G, van Gijn W, Wouters M, Post P, van de Velde C, Tollenaar R. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br. J. Surg. 2011; 98: 485-94.
Andren-Sandberg A, Neoptolemos JP. Resection for pancreatic cancer in the new millennium. Pancreatology 2002; 2: 431-9.
Boddy AP, Williamson JM, Vipond MN. The effect of centralisation on the outcomes of oesophagogastric surgery - a fifteen year audit. Int. J. Surg. 2012; 10: 360-3.
Varagunam M, Hardwick R, Riley S, Chadwick G, Cromwell DA, Groene O. Changes in volume, clinical practice and outcome after reorganisation of oesophago-gastric cancer care in England: a longitudinal observational study. Eur. J. Surg. Oncol. 2018; 44: 524-31.
Wouters M, Karim-Kos H, Cessie S et al. Centralization of esophageal cancer surgery: does it improve clinical outcome? Ann. Surg. Oncol. 2009; 16: 1789-98.
Lemmens VE, Bosscha K, van der Schelling G, Brenninkmeijer S, Coebergh JW, de Hingh IH. Improving outcome for patients with pancreatic cancer through centralization. Br. J. Surg. 2011; 98: 1455-62.
Waterhouse MA, Burmeister EA, O'Connell DL et al. Determinants of outcomes following resection for pancreatic cancer - a population-based study. J. Gastrointest. Surg. 2016; 20: 1471-81.
Meng R, Bright T, Woodman RJ, Watson DI. Hospital volume versus outcome following oesophagectomy for cancer in Australia and New Zealand. ANZ J. Surg. 2019; 89: 683-8.
Burton PR, Ooi GJ, Shaw K, Smith AI, Brown WA, Nottle PD. Assessing quality of care in oesophago-gastric cancer surgery in Australia. ANZ J. Surg. 2018; 88: 290-5.
Davis SS, Babidge WJ, Kiermeier A, Aitken RJ, Maddern GJ. Perioperative mortality following oesophagectomy and pancreaticoduodenectomy in Australia. World J. Surg. 2018; 42: 742-8.
Joseph B, Morton JM, Hernandez-Boussard T, Rubinfeld I, Faraj C, Velanovich V. Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. J. Am. Coll. Surg. 2009; 208: 520-7.
http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/8C5F5BB699A0921CCA258259000BA619?opendocument
Quan H, Li B, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am. J. Epidemiol. 2011; 173: 676-82.
Sobin LH, Gospodarowicz MK, Wittekind C (eds). International Union Against Cancer (UICC). TNM Classification of Malignant Tumours, 7th edn. Hoboken, NJ: Wiley-Blackwell, 2010.
Queensland Government. Queensland Oesophagogastric Surgery Quality Index: Indicators of Safe, Quality Cancer Care. Cancer Surgery in Public and Private Hospitals 2004-2013. Brisbane: Queensland Health, 2017.
Queensland Government. Pancreaticoduodenectomy in Queensland Public and Private Hospitals 2004-2013. Brisbane: Queensland Health, 2015.
Australian Institute of Health and Welfare. Australian hospital peer groups. Health Services Series No. 66. Cat. No. HSE 170, 2015. Canberra: AIHW.
Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998; 280: 1747-51.
Birkmeyer JD, Siewers AE, Finlayson EVA et al. Hospital volume and surgical mortality in the United States. N. Engl. J. Med. 2002; 346: 1128-37.
Sutton JM, Wilson GC, Paquette IM et al. Cost effectiveness after a pancreaticoduodenectomy: bolstering the volume argument. HPB 2014; 16: 1056-61.
Stavrou EP, McElroy HJ, Baker DF, Smith G, Bishop JF. Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972-2005. Med. J. Aust. 2009; 191: 310-4.
Ghaferi AA, Birkmeyer JD, Osborne NH, Dimick JB. Hospital characteristics associated with failure to rescue in high risk cancer surgery. J. Am. Coll. Surg. 2010; 211: 325-30.