Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1846–1852

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

  • David L. Smith
  • Linda S. Elting
  • Peter A. Learn
  • Chandrajit P. Raut
  • Paul F. Mansfield

DOI: 10.1245/s10434-007-9381-0

Cite this article as:
Smith, D.L., Elting, L.S., Learn, P.A. et al. Ann Surg Oncol (2007) 14: 1846. doi:10.1245/s10434-007-9381-0



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.


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.


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).


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.


Gastrectomies Volume-outcome Population based Nursing staffing 

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • David L. Smith
    • 1
  • Linda S. Elting
    • 2
  • Peter A. Learn
    • 1
  • Chandrajit P. Raut
    • 3
  • Paul F. Mansfield
    • 4
  1. 1.Department of SurgeryWilford Hall Medical CenterLackland AFBUSA
  2. 2.Department of BiostatisticsUniversity of Texas M. D. Anderson Cancer CenterHoustonUSA
  3. 3.Division of Surgical OncologyBrigham and Women’s HospitalBostonUSA
  4. 4.Department of Surgical OncologyUniversity of Texas M. D. Anderson Cancer CenterHoustonUSA

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