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Annals of Surgical Oncology 15(1):80–87 DOI: 10.1245/s10434-007-9673-4 High-Volume versus Low-Volume for Esophageal Resections for Cancer: The Essential Role of Case-Mix Adjustments based on Clinical Data
BibTeX
@MISC{Blaauwgeers_annalsof,
author = {Harriet G. Blaauwgeers and Laurents P. Stassen},
title = {Annals of Surgical Oncology 15(1):80–87 DOI: 10.1245/s10434-007-9673-4 High-Volume versus Low-Volume for Esophageal Resections for Cancer: The Essential Role of Case-Mix Adjustments based on Clinical Data},
year = {}
}
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Abstract
Background: Most studies addressing the volume–outcome relationship in complex surgical procedures use hospital mortality as the sole outcome measure and are rarely based on detailed clinical data. The lack of reliable information about comorbidities and tumor stages makes the conclusions of these studies debatable. The purpose of this study was to compare outcomes for esophageal resections for cancer in low- versus high-volume hospitals, using an extensive set of variables concerning case-mix and outcome measures, including long-term survival. Methods: Clinical data, from 903 esophageal resections performed between January 1990 and December 1999, were retrieved from the original patientsÕ files. Three hundred and fortytwo patients were operated on in 11 low-volume hospitals (<7 resections/year) and 561 in a single high-volume center. Results: Mortality and morbidity rates were significantly lower in the high-volume center, which had an in-hospital mortality of 5 vs 13 % (P <.001). On multivariate analysis, hospital volume, but also the presence of comorbidity proved to be strong prognostic factors predicting in-hospital mortality (ORs 3.05 and 2.34). For stage I and II disease, there was a significantly
Keyphrases
esophageal resection clinical data case-mix adjustment essential role surgical oncology s10434-007-9673-4 high-volume versus low-volume in-hospital mortality low-volume hospital long-term survival hospital volume multivariate analysis complex surgical procedure fortytwo patient sole outcome measure volume outcome relationship ii disease detailed clinical data hospital mortality high-volume center outcome measure reliable information original patient file tumor stage low versus high-volume hospital resection year morbidity rate extensive set single high-volume center strong prognostic factor
