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Trends in Major Gastrectomy for Cancer: Frequency and Outcomes

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Declining incidence of gastric cancer in the USA has presumably resulted in lower rates of major gastrectomy for cancer. The impact on perioperative outcomes remains undefined. The aims of this study were to characterize national trends in frequency of major gastrectomy for cancer, identify factors associated with in-hospital mortality, and examine outcome disparities by race/ethnicity.

Methods

Nationwide inpatient sample data from 1993 to 2013 were queried for procedural and diagnostic codes (ICD-9) relating to total and partial gastrectomy procedures. Gastric resections for cancer were compared to those for peptic ulcer disease for reference. Patient demographics, comorbidity score, mortality, and hospital characteristics were recorded as covariates.

Results

A significant decrease in annual rates of partial and total gastrectomy was observed from 1993 to 2013 (p < 0.0001). The change in absolute number and percent decline was greater for partial gastrectomy (− 39.3%) than total gastrectomy (− 19%). There was a 34.0% decrease in gastrectomy for cancer in Whites and a 61.2% increase among Hispanic patients over two decades. In-hospital mortality also significantly decreased over the study period (7.7% to 2.7%). Factors associated with lower mortality rates included male sex and treatment at urban teaching hospitals. Analysis of trends revealed that gastrectomy for cancer was performed with increasing frequency at urban teaching hospitals.

Conclusions

The frequency of major gastric resections in the USA has declined over two decades. Overall, in-hospital mortality rates also have decreased significantly. Declining in-hospital mortality after gastrectomy for cancer is associated with more frequent treatment at urban teaching hospitals.

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Acknowledgements

The authors wish to thank Harshini Chinnasamy for her assistance with data acquisition.

Author information

Authors and Affiliations

  1. Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3742, Bethesda, MD, 20892, USA

    Eric M. Groh, R. Taylor Ripley, Jonathan M. Hernandez & Jeremy L. Davis

  2. Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Noorie Hyun

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA

    David Check & Barry I. Graubard

  4. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, 20892, USA

    Theo Heller

  5. NIH Foregut Team, Center for Cancer Research, National Institutes of Health, Bethesda, MD, 20892, USA

    Theo Heller, R. Taylor Ripley, Jonathan M. Hernandez & Jeremy L. Davis

Authors
  1. Eric M. Groh
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  2. Noorie Hyun
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  3. David Check
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  4. Theo Heller
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  7. Barry I. Graubard
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  8. Jeremy L. Davis
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Contributions

Study conception and design: E.M. Groh, N. Hyun, B.I. Graubard, J.L. Davis.

Acquisition of data: E.M. Groh, N. Hyun.

Analysis and interpretation of data: E.M. Groh, N. Hyun, D. Check, T. Heller, B.I. Graubard, J.M. Hernandez, R.T. Ripley, J.L. Davis.

Drafting of manuscript: E.M. Groh, N. Hyun, T. Heller, R.T. Ripley, J.M. Hernandez, J.L. Davis.

Critical revisions: E.M. Groh, N. Hyun, D. Check, T. Heller, B.I. Graubard, R.T. Ripley, J.M. Hernandez, J.L. Davis.

Corresponding author

Correspondence to Jeremy L. Davis.

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Funding

This study was supported by the Intramural Research Program, National Cancer Institute, National Institutes of Health.

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Groh, E.M., Hyun, N., Check, D. et al. Trends in Major Gastrectomy for Cancer: Frequency and Outcomes. J Gastrointest Surg 23, 1748–1757 (2019). https://doi.org/10.1007/s11605-018-4061-x

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  • DOI: https://doi.org/10.1007/s11605-018-4061-x

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