National Trends in Esophageal Surgery—Are Outcomes as Good as We Believe?
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Positive volume–outcome relationships in esophagectomy have prompted support for regionalization of care; however, outcomes have not recently been analyzed. This study examines national trends in provision of esophagectomy and reassesses the volume–outcome relationship in light of changing practice patterns and training paradigms.
The Nationwide Inpatient Sample was queried from 1998 to 2006. Quantification of patients’ comorbidities was made using the Charlson Index. Using logistic regression modeling, institutions’ annual case volumes were correlated with risk-adjusted outcomes over time, as well as presence or absence of fellowship and residency training programs.
A nationwide total of 57,676 esophagectomies were recorded. In-hospital unadjusted mortality fell from 12% to 7%. Adjusting for comorbidities, greater esophagectomy volume was associated with improvements in the incidence of most measured complications, though mortality increased once greater than 100 cases were performed. Hospitals supporting fellowship training or a surgical residency program did not have higher rates of mortality or total complications.
The current national mortality rate of 7% following esophagectomy is higher than is reported in most contemporary case series. A greater annual esophagectomy volume improves outcomes, but only up to a point. Current training paradigms are safe.
KeywordsEsophagectomy Training programs Residency and internship Factual databases Trends
- 2.Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2006. Bethesda: National Cancer Institute. http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site, 2009.
- 3.U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2005 Incidence and Mortality Web-Based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, 2009. Available at: www.cdc.gov/uscs.
- 9.Alderson D. Scottish Intercollegiate Guidelines Network (SIGN) 87—the management of oesophageal and gastric cancer. Clin Oncol (R Coll Radiol) 2008;20(7):530–531.Google Scholar
- 10.National Comprehensive Cancer Network. Clinical practice guidelines in oncology: esophageal cancer. Fort Washington: National Comprehensive Cancer Network, 2009.Google Scholar
- 11.The Leapfrog Group. Evidence-Based Hospital Referral (EBHR) and Common Acute Conditions (CACs) Coding Specifications for Volume v5.1.1. Washington, DC: The Leapfrog Group, 2008.Google Scholar
- 12.The Leapgfrog Group Factsheet: Evidence-Based Hospital Referral http://www.leapfroggroup.org/media/file/FactSheet_EBHR.pdf. Accessed May 3, 2009.
- 32.HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 1998–2006. Rockville: Agency for Healthcare Research and Quality. www.hcup-us.ahrq.gov/nisoverview.jsp.
- 33.The Fellowship Council website. Directory of Fellowships https://fellowshipcouncil.org/directory/browse2.php. Accessed September 11, 2008.
- 34.National Resident Matching Program. Website http://www.nrmp.org/fellow/match_name/thoracic/prev.html. Accessed April 29, 2009.
- 35.The Society of Surgical Oncology. Website http://surgonc.org/default.aspx?id=60#1. Access April 29, 2009.
- 36.American Medical Association website. FREIDA Online GME program search results. https://freida.ama-assn.org/Freida/user/programSearchSubmitDispatch.do. Accessed November 26, 2008.
- 37.Accreditation Council for Graduate Medical Education. website http://www.acgme.org/adspublic/. Access Novermber 26, 2008.
- 38.Healthcare Cost and Utilization Project (HCUP). 1998–2006 [database online]. Insert City of Publication Here see notes: Agency for Healthcare Research and Quality, Rockville, MD.Google Scholar
- 40.Scottish Intercollegiate Guidelines Network. Scottish Intercollegiate Guidelines Network (SIGN) 87—the management of oesophageal and gastric cancer: A national clinical guideline. Edinburgh: SIGN, 2006.Google Scholar
- 41.Kohn GP, Galanko JA, Overby DW et al. Volume–outcome relationships and other influences of outcome in bariatric surgery. Surg Endosc 2009;23(S1):149.Google Scholar