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Trends in Volume–Outcome Relationship in Gastrectomies in Texas

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We previously reported a significant volume–outcome relationship in mortality rates after gastrectomies for gastric cancer patients in Texas (1999–2001). We aimed to identify whether changes in the volume distribution of gastrectomies occurred, whether volume–outcome relationships persisted, and potential changes in the factors influencing volume–outcome relationships.

Methods

We performed a population-based study using the Texas Inpatient Public Use Data File between 2010 and 2015. Hospitals were classified as high-volume centers (HVCs, > 15 cases per year), intermediate-volume centers (IVCs, 3–15 cases per year), and low-volume centers (LVCs, < 3 cases per year). We conducted multivariate analyses to evaluate factors associated with inpatient mortality and adverse events.

Results

We identified 2733 gastric cancer patients who underwent gastrectomy at 193 hospitals. Fewer hospitals performed gastrectomy than previously (193 vs. 214). There were more HVCs (5 vs. 2) and LVCs (142 vs. 134), but fewer IVCs (46 vs. 78). The proportion of patients who underwent gastrectomy at HVCs and LVCs increased, while the proportion at IVCs decreased. HVCs maintained lower in-hospital mortality rates than IVCs or LVCs, although mortality rates decreased in both LVCs and IVCs. In adjusted multivariate analyses, treatment at HVCs remained a strong predictor for lower rates of mortality (odds ratio [OR] 0.39, p = 0.019) and adverse events (OR 0.56, p = 0.013).

Conclusion

Despite improvements, patient morbidity and mortality at LVCs and IVCs remain higher than at HVCs, demonstrating that volume–outcome relationships still exist for gastrectomy and that opportunities for improvement remain.

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Acknowledgment

The authors thank the Department of Scientific Publications, MD Anderson Cancer Center, for editorial assistance.

Funding

This work was supported in part by the National Institutes of Health under Cancer Center Support Grants P30CA016672 and R01CA207216; the Clinical Trials Support Resource was used. Funding from Sun and Do Lee Research and Patient Care Fund, and the Robert F. Fly Professorship, was also used to support this study.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Naruhiko Ikoma MD, MS, Brian D. Badgwell MD, MS & Paul Mansfield MD

  2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bumyang Kim PhD, Linda S. Elting DrPH & Ya-Chen Tina Shih PhD

Authors
  1. Naruhiko Ikoma MD, MS
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  2. Bumyang Kim PhD
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  3. Linda S. Elting DrPH
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  4. Ya-Chen Tina Shih PhD
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  5. Brian D. Badgwell MD, MS
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  6. Paul Mansfield MD
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Corresponding author

Correspondence to Paul Mansfield MD.

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Disclosures

Naruhiko Ikoma, Bumyang Kim, Linda S. Elting, Ya-Chen Tina Shih, Brian D. Badgwell, and Paul Mansfield have no conflicts of interest to disclose.

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Ikoma, N., Kim, B., Elting, L.S. et al. Trends in Volume–Outcome Relationship in Gastrectomies in Texas. Ann Surg Oncol 26, 2694–2702 (2019). https://doi.org/10.1245/s10434-019-07446-0

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  • DOI: https://doi.org/10.1245/s10434-019-07446-0

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