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Annals of Surgical Oncology

Published in:

01-06-2007

Factors Influencing the Volume-Outcome Relationship in Gastrectomies: A Population-Based Study

Authors: David L. Smith, MD, Linda S. Elting, DrPH, Peter A. Learn, MD, Chandrajit P. Raut, MD, Paul F. Mansfield, MD

Published in: Annals of Surgical Oncology | Issue 6/2007

Abstract

Background

A relationship between hospital procedural volume and patient outcomes has been observed in gastrectomies for primary gastric cancer, but modifiable factors influencing this relationship are not well elaborated.

Methods

We performed a population-based study of 1864 patients undergoing gastrectomy for primary gastric cancers at 214 hospitals. Hospitals were stratified as high-, intermediate-, or low-volume centers. Multivariate models were constructed to evaluate the effect of institutional procedural volume and other hospital- and patient-specific factors on the risk of in-hospital mortality, adverse events, and failure to rescue, defined as mortality after an adverse event.

Results

High-volume centers attained an in-hospital mortality rate of 1.0% and failure-to-rescue rate of .7%, both less than one-fifth of that seen at intermediate- and low-volume centers, although adverse event rates were similar across the three volume tiers. In multivariate modeling, treatment at a high-volume hospital decreased the odds of mortality (odds ratio [OR], .22; 95% confidence interval [95% CI], .05–.89), whereas treatment at an institution with a high ratio of licensed vocational nurses per bed increased the odds of mortality (OR, 1.96; 95% CI, 1.04–3.75). Being treated at a hospital with a greater than median number of critical care beds decreased odds of mortality (OR, .46; 95% CI, .25–.81) and failure to rescue (OR, .53; 95% CI, .29–.97).

Conclusions

Undergoing gastrectomy at a high-volume center is associated with lower in-hospital mortality. However, improving the rates of mortality after adverse events and reevaluating nurse staffing ratios may provide avenues by which lower-volume centers can improve mortality rates.

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Title: Factors Influencing the Volume-Outcome Relationship in Gastrectomies: A Population-Based Study
Authors: David L. Smith, MD
Linda S. Elting, DrPH
Peter A. Learn, MD
Chandrajit P. Raut, MD
Paul F. Mansfield, MD
Publication date: 01-06-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9381-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors Influencing the Volume-Outcome Relationship in Gastrectomies: A Population-Based Study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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