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Correlation Between the Increased Hospital Volume and Decreased Overall Perioperative Mortality in One Universal Health Care System

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Abstract

Background

Volume–outcome relationship has been demonstrated extensively for short-term outcomes for oncological surgery. However, its effect on long-term surgical outcomes or in one universal health care (UHC) system is unknown. This retrospective population-based study aims to validate the correlation between the increased hospital volume and better short- and long-term outcomes in patients who underwent total gastrectomy (TG) for gastric cancer.

Methods

From the Taiwan National Health Insurance Research Database, we examined 7905 patients who underwent TG between 2000 and 2010. The surgical outcomes of this study were defined as death within 30, 60, and 180 days after TG.

Results

A total of 7905 subjects were included for analysis. The mean age was 65.8 years, and 68.8% were males. The 30-, 60-, and 180-day mortality rates after TG for gastric cancer were 2.7%, 6.2%, and 18.2%, respectively. On the multivariate analysis, TG at high-volume hospitals significantly contributed to lower 30-day (odds ratio 0.64; 95% confidence interval 0.48–0.85; P < 0.001), 60-day (odds ratio 0.68; 95% confidence interval 0.56–0.82; P < 0.001), and 180-day mortality rates (odds ratio 0.80; 95% confidence interval 0.70–0.90; P < 0.001).

Conclusions

Although TG is a complex operation with high mortality rates (~180-day), high hospital volume correlates with better perioperative outcomes even in UHC system. Hence, the strategy to advocate the centralization of TG is reasonable, especially for the elderly.

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Abbreviations

TG:

Total gastrectomy

CI:

Confidence interval

DM:

Diabetes mellitus

NHIRD:

National Health Insurance Research Database

ICD-9-CM:

International Classification of Disease, Ninth Revision, Clinical Modification

References

  1. Okholm C, Svendsen LB, Achiam MP (2014) Status and prognosis of lymph node metastasis in patients with cardia cancer—a systematic review. Surg Oncol 23:140–146

    Article  PubMed  Google Scholar 

  2. Gao S, Zhou F, Zhao C et al (2016) Gastric cardia adenocarcinoma microRNA profiling in Chinese patients. Tumour Biol 37:9411–9422

    Article  CAS  PubMed  Google Scholar 

  3. Dubecz A, Solymosi N, Stadlhuber RJ et al (2014) Does the incidence of adenocarcinoma of the esophagus and gastric cardia continue to rise in the twenty-first century?—a SEER database analysis. J Gastrointest Surg 18:124–129

    Article  Google Scholar 

  4. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  Google Scholar 

  5. Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34:137–168

    Article  CAS  PubMed  Google Scholar 

  6. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137

    Article  Google Scholar 

  7. Sugoor P, Shah S, Dusane R et al (2016) Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg 401:687–697

    Article  PubMed  Google Scholar 

  8. Lin HC, Xirasagar S, Lee HC et al (2006) Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country. Ann Surg Oncol 13:1182–1188

    Article  PubMed  Google Scholar 

  9. LaPar DJ, Bhamidipati CM, Mery CM et al (2010) Primary payer status affects mortality for major surgical operations. Ann Surg 252:544–550 discussion 550-541

    PubMed  PubMed Central  Google Scholar 

  10. Xiao D, Zheng C, Jindal M et al (2018) Medicaid expansion and disparity reduction in surgical cancer care at high-quality hospitals. J Am Coll Surg 226:22–29

    Article  PubMed  Google Scholar 

  11. Khuri SF, Daley J, Henderson W et al (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228:491–507

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Weledji EP, Verla V (2016) Failure to rescue patients from early critical complications of oesophagogastric cancer surgery. Ann Med Surg (Lond) 7:34–41

    Article  Google Scholar 

  13. Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 250:1029–1034

    Article  PubMed  Google Scholar 

  14. Mise Y, Vauthey JN, Zimmitti G et al (2015) Ninety-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality. Ann Surg 262:1071–1078

    Article  PubMed  PubMed Central  Google Scholar 

  15. Byrne BE, Mamidanna R, Vincent CA et al (2013) Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery. Br J Surg 100:1810–1817

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Shirabe K, Shimada M, Gion T et al (1999) Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg 188:304–309

    Article  CAS  PubMed  Google Scholar 

  17. Wu CY, Chen YJ, Ho HJ et al (2012) Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA 308:1906–1914

    Article  CAS  PubMed  Google Scholar 

  18. Ho TW, Wu JM, Yang CY et al (2016) Total gastrectomy improves glucose metabolism on gastric cancer patients: a nationwide population-based study. Surg Obes Relat Dis 12:635–641

    Article  PubMed  Google Scholar 

  19. Tsai MS, Wang YC, Kao YH et al (2015) Preexisting diabetes and risks of morbidity and mortality after gastrectomy for gastric cancer: a nationwide database study. Medicine (Baltimore) 94:e1467

    Article  Google Scholar 

  20. Coe TM, Rose JA, Chang DC (2014) Expanding our understanding of patient outcomes: the unique role of health services research in the continuing evolution of surgical science. Vasc Endovasc Surg 48:356–358

    Article  Google Scholar 

  21. Ailon T, Tee J, Manson N et al (2019) Patient-reported outcomes following surgery for degenerative spondylolitshtesis: comparison of a universal and multitier health care system. Spine J 19:24–33

    Article  PubMed  Google Scholar 

  22. Watkins DA, Jamison DT, Mills T et al (2017) Universal health coverage and essential packages of care. In: Jamison DT, Gelband H, et al (eds) Disease control priorities: improving health and reducing poverty, chap 3. The International Bank for Reconstruction and Development/The World Bank, Washington, DC

    Google Scholar 

  23. Petrou P, Samoutis G, Lionis C (2018) Single-payer or a multipayer health system: a systematic literature review. Public Health 163:141–152

    Article  CAS  PubMed  Google Scholar 

  24. Cheng TM (2015) Reflections on the 20th anniversary of Taiwan’s single-payer National Health Insurance System. Health Aff (Millwood) 34:502–510

    Article  Google Scholar 

  25. Jacobs K, Lucia L (2018) Universal Health Care: lessons from San Francisco. Health Aff (Millwood) 37:1375–1382

    Article  Google Scholar 

  26. Ganti S, Hadad S, Sheffield Surgical Journal C (2012) Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types (Br J Surg 2012; 99: 1149–1154). Br J Surg 99:1602; author reply 1602–1603

  27. Watanabe M, Miyata H, Gotoh M et al (2014) Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 260:1034–1039

    Article  PubMed  Google Scholar 

  28. Selby LV, Vertosick EA, Sjoberg DD et al (2015) Morbidity after total gastrectomy: analysis of 238 patients. J Am Coll Surg 220(863–871):e862

    Google Scholar 

  29. Bartlett EK, Roses RE, Kelz RR et al (2014) Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery 156:298–304

    Article  PubMed  Google Scholar 

  30. Stitzenberg KB, Meropol NJ (2010) Trends in centralization of cancer surgery. Ann Surg Oncol 17:2824–2831

    Article  PubMed  Google Scholar 

  31. Massarweh NN, Anaya DA, Kougias P et al (2017) Variation and impact of multiple complications on failure to rescue after inpatient surgery. Ann Surg 266:59–65

    Article  PubMed  Google Scholar 

  32. Shu B, Lei S, Li F et al (2015) Short and long-term outcomes after gastrectomy for gastric carcinoma in elderly patients. Int J Clin Exp Med 8:13578–13584

    PubMed  PubMed Central  Google Scholar 

  33. Opelz G, Terasaki PI (1980) Dominant effect of transfusions on kidney graft survival. Transplantation 29:153–158

    Article  CAS  PubMed  Google Scholar 

  34. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 1:CD005033

    Google Scholar 

  35. Ejaz A, Spolverato G, Kim Y et al (2015) Impact of blood transfusions and transfusion practices on long-term outcome following hepatopancreaticobiliary surgery. J Gastrointest Surg 19:887–896

    Article  PubMed  Google Scholar 

  36. Ferraris VA, Davenport DL, Saha SP et al (2012) Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg 147:49–55

    Article  PubMed  Google Scholar 

  37. Odell DD, Bilimoria KY (2016) Evaluating appropriate blood transfusion in cancer surgery. JAMA Surg 151:525–526

    Article  PubMed  Google Scholar 

  38. Epelboym I, Gawlas I, Lee JA et al (2014) Limitations of ACS-NSQIP in reporting complications for patients undergoing pancreatectomy: underscoring the need for a pancreas-specific module. World J Surg 38:1461–1467. https://doi.org/10.1007/s00268-013-2439-1

    Article  PubMed  Google Scholar 

  39. Baker RS, Foote J, Kemmeter P et al (2004) The science of stapling and leaks. Obes Surg 14:1290–1298

    Article  PubMed  Google Scholar 

  40. Lee WJ, Chen TC, Lai IR et al (2003) Randomized clinical trial of Ligasure versus conventional surgery for extended gastric cancer resection. Br J Surg 90:1493–1496

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study is based on data from the Collaboration Center of Health Information Application of the Ministry of Health and Welfare, which had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study was supported by Grants from the Ministry of Science and Technology, Taiwan (MOST 105-2221-E-002-192 & 107-2634-F-002-015), and from the National Taiwan University Hospital (105-N3315).

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Author notes

  1. Te-Wei Ho and Yu-Wen Tien have equally contributed to this work as corresponding authors.

Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC

    Jin-Ming Wu, Te-Wei Ho & Yu-Wen Tien

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  1. Jin-Ming Wu
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  2. Te-Wei Ho
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Wu, JM., Ho, TW. & Tien, YW. Correlation Between the Increased Hospital Volume and Decreased Overall Perioperative Mortality in One Universal Health Care System. World J Surg 43, 2194–2202 (2019). https://doi.org/10.1007/s00268-019-05025-8

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