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Hospital Volume and Inpatient Mortality After Cancer-Related Gastrointestinal Resections: The Experience of an Asian Country

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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Using 4-year nationwide population-based data for Taiwan, this study compared in-hospital surgical mortality rates with hospital volume for five cancer-related gastrointestinal resections.

Methods

The study sample was drawn from the Taiwan National Health Insurance Research Database. A total of 34,715 patients, each of whom had undergone a cancer-related colectomy, gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between 2000 and 2003, were selected as the study sample. The outcome measure was in-hospital mortality. The study sample was categorized into five patient groups for each procedure, and logistic regression analyses were performed for each procedure after adjustment for hospital and patient characteristics to assess the independent association between hospital volume and in-hospital mortality.

Results

The adjusted odds ratios showed a steady decline in mortality rates for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing hospital volume. The adjusted mortality odds for these four procedures in very-high-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to .05. As regards pancreatic resection, after adjustment for patient, clinical, and hospital factors, no statistically significant association was discernible between hospital volume and the likelihood of mortality.

Conclusions

After adjustment for hospital and physician characteristics, in four of the five procedures, patients treated at higher-volume hospitals had lower in-hospital mortality rates than those treated at lower-volume hospitals. Our findings confirm, for the most part, the hypothesis that better outcomes are associated with higher-volume hospitals.

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Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by the National Health Research Institutes, Taiwan. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.

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Authors and Affiliations

  1. School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

    Herng-Ching Lin PhD

  2. Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA

    Sudha Xirasagar MBBS, PhD

  3. Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan

    Hsin-Chien Lee MD, MPH

  4. Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan

    Chiah-Yang Chai MD

Authors
  1. Herng-Ching Lin PhD
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  2. Sudha Xirasagar MBBS, PhD
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  3. Hsin-Chien Lee MD, MPH
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  4. Chiah-Yang Chai MD
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Corresponding author

Correspondence to Herng-Ching Lin PhD.

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Lin, HC., Xirasagar, S., Lee, HC. et al. Hospital Volume and Inpatient Mortality After Cancer-Related Gastrointestinal Resections: The Experience of an Asian Country. Ann Surg Oncol 13, 1182–1188 (2006). https://doi.org/10.1245/s10434-006-9005-0

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  • DOI: https://doi.org/10.1245/s10434-006-9005-0

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