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Gastrectomy case volume and textbook outcome: an analysis of the Population Registry of Esophageal and Stomach Tumours of Ontario (PRESTO)

  • Jordan Levy
  • Vaibhav Gupta
  • Elmira Amirazodi
  • Catherine Allen-Ayodabo
  • Naheed Jivraj
  • Yunni Jeong
  • Laura E. Davis
  • Alyson L. Mahar
  • Charles De Mestral
  • Olli Saarela
  • Natalie CoburnEmail author
  • on behalf of the PRESTO Group
Original Article

Abstract

Objective

To determine the association between gastric cancer surgery case-volume and Textbook Outcome, a new composite quality measurement.

Background

Textbook Outcome included (a) negative resection margin, (b) greater than 15 lymph nodes sampled, (c) no severe complication, (d) no re-intervention, (e) no unplanned ICU admission, (f) length of stay of 21 days or less, (g) no 30-day readmission and (h) no 30-day mortality following surgery.

Methods

All patients undergoing gastrectomy for non-metastatic gastric adenocarcinoma registered in the Population Registry of Esophageal and Stomach Tumours of Ontario between 2004 and 2015 were included. We used multivariable generalized estimating equation (GEE) logistic regression modelling to estimate the association between gastrectomy volume (surgeon and hospital annual volumes) and Textbook Outcome. Volumes were considered as continuous variables and quintiles.

Results

Textbook Outcome was achieved in 378 of 1660 patients (22.8%). The quality metrics least often achieved were inadequate lymph node sampling and presence of severe complications, which occurred in 46.1% and 31.7% of patients, respectively. Accounting for covariates and clustering, neither surgeon volume nor hospital volume were significantly associated with Textbook Outcome. However, hospital volume was associated with adequate lymphadenectomy and fewer unplanned ICU admissions.

Conclusions

Higher case volume can impact certain measures of quality of care but may not address all care structures necessary for ideal Textbook recovery. Future quality improvement strategies should consider using case-mix adjusted Textbook Outcome rates as a surgical quality metric.

Keywords

Gastric cancer Gastrectomy Volume Surgical quality Textbook 

Notes

Acknowledgements

This study is financially supported by the Sherif and Mary Lou Hanna Chair in Surgical Oncology at Sunnybrook Health Sciences Centre and would not have been possible without the support of the PRESTO Group and its collaborators. PRESTO Group: Jordan Levy, MD. Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada. Vaibhav Gupta, MD. Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada. Elmira Amirazodi, MD, MSc. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. Catherine Allen-Ayodabo, MD, MPH. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. Naheed Jivraj, MBBS, MSc. Department of Anesthesia and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. Yunni Jeong, MD. Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada. Laura E. Davis, MSc. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. James R. Connor, MD, PhD. Department of Laboratory Medicine and Pathobiology, University of Toronto; Mount Sinai Hospital, Toronto, Canada. Eugene Hseih, MD. Department of Laboratory Medicine and Pathobiology, University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Canada. Jolie Ringash, MD, MSc. Department of Radiation Oncology and Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada. Rinku Sutradhar, PhD. Institute for Clinical Evaluative Sciences and Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada. Biniam Kidane, MD, MSc. Section of Thoracic Surgery, Department of Surgery, University of Manitoba. Gail E. Darling, MD. Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto; Toronto General Hospital/University Health Network, Toronto, Canada. Alyson L. Mahar, PhD. Manitoba Centre for Health Policy and Department of Community Health Sciences, University of Manitoba, Canada. Natalie G. Coburn, MD, MPH. Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Canada.

Supplementary material

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  • Jordan Levy
    • 1
  • Vaibhav Gupta
    • 1
  • Elmira Amirazodi
    • 2
  • Catherine Allen-Ayodabo
    • 2
  • Naheed Jivraj
    • 3
  • Yunni Jeong
    • 1
  • Laura E. Davis
    • 2
  • Alyson L. Mahar
    • 4
  • Charles De Mestral
    • 5
    • 6
  • Olli Saarela
    • 7
  • Natalie Coburn
    • 1
    • 8
    Email author
  • on behalf of the PRESTO Group
  1. 1.Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  2. 2.Evaluative Clinical SciencesSunnybrook Research InstituteTorontoCanada
  3. 3.Department of Anesthesia and Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  4. 4.Manitoba Centre for Health Policy and Department of Community Health SciencesUniversity of ManitobaTorontoCanada
  5. 5.Division of Vascular Surgery, Department of Surgery and Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Li Ka Shing Knowledge Institute and St. Michael’s HospitalTorontoCanada
  7. 7.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  8. 8.Sunnybrook Health Sciences CentreTorontoCanada

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