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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2009

Open Access 01-07-2009 | Healthcare Policy and Outcomes

Centralization of Esophageal Cancer Surgery: Does It Improve Clinical Outcome?

Authors: M. W. J. M. Wouters, MD, H. E. Karim-Kos, PhD, S. le Cessie, PhD, B. P. L. Wijnhoven, MD, PhD, L. P. S. Stassen, MD, PhD, W. H. Steup, MD, PhD, H. W. Tilanus, MD, PhD, R. A. E. M. Tollenaar, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2009

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Abstract

Background

The volume–outcome relationship for complex surgical procedures has been extensively studied. Most studies are based on administrative data and use in-hospital mortality as the sole outcome measure. It is still unknown if concentration of these procedures leads to improvement of clinical outcome. The aim of our study was to audit the process and effect of centralizing oesophageal resections for cancer by using detailed clinical data.

Methods

From January 1990 until December 2004, 555 esophagectomies for cancer were performed in 11 hospitals in the region of the Comprehensive Cancer Center West (CCCW); 342 patients were operated on before and 213 patients after the introduction of a centralization project. In this project patients were referred to the hospitals which showed superior outcomes in a regional audit. In this audit patient, tumor, and operative details as well as clinical outcome were compared between hospitals. The outcome of both cohorts, patients operated on before and after the start of the project, were evaluated.

Results

Despite the more severe comorbidity of the patient group, outcome improved after centralizing esophageal resections. Along with a reduction in postoperative morbidity and length of stay, mortality fell from 12% to 4% and survival improved significantly (P = 0.001). The hospitals with the highest procedural volume showed the biggest improvement in outcome.

Conclusion

Volume is an important determinant of quality of care in esophageal cancer surgery. Referral of patients with esophageal cancer to surgical units with adequate experience and superior outcomes (outcome-based referral) improves quality of care.
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Metadata
Title
Centralization of Esophageal Cancer Surgery: Does It Improve Clinical Outcome?
Authors
M. W. J. M. Wouters, MD
H. E. Karim-Kos, PhD
S. le Cessie, PhD
B. P. L. Wijnhoven, MD, PhD
L. P. S. Stassen, MD, PhD
W. H. Steup, MD, PhD
H. W. Tilanus, MD, PhD
R. A. E. M. Tollenaar, MD, PhD
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0458-9

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