Hospital surgical volume and perioperative mortality of pelvic exenteration for gynecologic malignancies.
morbidity
mortality
pelvic exenteration
surgical volume
volume-outcome relation
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
27
10
2019
accepted:
07
11
2019
pubmed:
21
11
2019
medline:
21
11
2019
entrez:
21
11
2019
Statut:
ppublish
Résumé
To examine the association between hospital surgical volume and perioperative mortality of pelvic exenteration performed for gynecologic malignancies. A population-based retrospective study utilizing the Nationwide Inpatient Sample was conducted to examine pelvic exenteration for gynecologic malignancies from 2001 to 2011. Annualized hospital surgical volume was defined as the average number of procedures a hospital performed per year in which at least one case was performed, and this was correlated to perioperative mortality. A total 1912 exenterations performed at 181 centers were included. Nearly two thirds of exenteration-performing centers had a minimum surgical volume of one case per year (121 centers, 66.9%). Perioperative mortality rate was 1.8%. In multivariable analysis surgical volume remained an independent factor for perioperative mortality (adjusted-odds ratio 0.21; 95% confidence interval, 0.09-0.49; P < .001). Perioperative mortality rates were 3.7% for the centers with minimum surgical volume (1 exenteration a year), 1.4% for the centers performing more than one but two or less exenterations a year, and 0% for the top decile centers (>2 exenterations a year), respectively (P < .001). Pelvic exenteration for gynecologic malignancy is a rare surgical procedure with most hospitals performing few cases annually. A higher surgical volume of pelvic exenteration was associated with lower perioperative mortality.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
To examine the association between hospital surgical volume and perioperative mortality of pelvic exenteration performed for gynecologic malignancies.
METHODS
METHODS
A population-based retrospective study utilizing the Nationwide Inpatient Sample was conducted to examine pelvic exenteration for gynecologic malignancies from 2001 to 2011. Annualized hospital surgical volume was defined as the average number of procedures a hospital performed per year in which at least one case was performed, and this was correlated to perioperative mortality.
RESULTS
RESULTS
A total 1912 exenterations performed at 181 centers were included. Nearly two thirds of exenteration-performing centers had a minimum surgical volume of one case per year (121 centers, 66.9%). Perioperative mortality rate was 1.8%. In multivariable analysis surgical volume remained an independent factor for perioperative mortality (adjusted-odds ratio 0.21; 95% confidence interval, 0.09-0.49; P < .001). Perioperative mortality rates were 3.7% for the centers with minimum surgical volume (1 exenteration a year), 1.4% for the centers performing more than one but two or less exenterations a year, and 0% for the top decile centers (>2 exenterations a year), respectively (P < .001).
CONCLUSION
CONCLUSIONS
Pelvic exenteration for gynecologic malignancy is a rare surgical procedure with most hospitals performing few cases annually. A higher surgical volume of pelvic exenteration was associated with lower perioperative mortality.
Identifiants
pubmed: 31746006
doi: 10.1002/jso.25770
pmc: PMC7523231
mid: NIHMS1627651
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
402-409Subventions
Organisme : NCI NIH HHS
ID : P30 CA014089
Pays : United States
Organisme : Ensign Endowment for Gynecologic Cancer Research, USA
Informations de copyright
© 2019 Wiley Periodicals, Inc.
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