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Factors Influencing the Volume-Outcome Relationship in Gastrectomies: A Population-Based Study

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Abstract

Background

A relationship between hospital procedural volume and patient outcomes has been observed in gastrectomies for primary gastric cancer, but modifiable factors influencing this relationship are not well elaborated.

Methods

We performed a population-based study of 1864 patients undergoing gastrectomy for primary gastric cancers at 214 hospitals. Hospitals were stratified as high-, intermediate-, or low-volume centers. Multivariate models were constructed to evaluate the effect of institutional procedural volume and other hospital- and patient-specific factors on the risk of in-hospital mortality, adverse events, and failure to rescue, defined as mortality after an adverse event.

Results

High-volume centers attained an in-hospital mortality rate of 1.0% and failure-to-rescue rate of .7%, both less than one-fifth of that seen at intermediate- and low-volume centers, although adverse event rates were similar across the three volume tiers. In multivariate modeling, treatment at a high-volume hospital decreased the odds of mortality (odds ratio [OR], .22; 95% confidence interval [95% CI], .05–.89), whereas treatment at an institution with a high ratio of licensed vocational nurses per bed increased the odds of mortality (OR, 1.96; 95% CI, 1.04–3.75). Being treated at a hospital with a greater than median number of critical care beds decreased odds of mortality (OR, .46; 95% CI, .25–.81) and failure to rescue (OR, .53; 95% CI, .29–.97).

Conclusions

Undergoing gastrectomy at a high-volume center is associated with lower in-hospital mortality. However, improving the rates of mortality after adverse events and reevaluating nurse staffing ratios may provide avenues by which lower-volume centers can improve mortality rates.

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ACKNOWLEDGMENTS

Supported by William Randolph Hearst Foundations and the Carlos Cantu Foundation Fund for Research in Surgical Oncology.

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Authors and Affiliations

  1. Department of Surgery, Wilford Hall Medical Center, 2200 Bergquist Drive/Ste 1, Lackland AFB, Texas, 78236, USA

    David L. Smith MD & Peter A. Learn MD

  2. Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 447, Houston, Texas, 77030, USA

    Linda S. Elting DrPH

  3. Division of Surgical Oncology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, 02115, USA

    Chandrajit P. Raut MD

  4. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 447, Houston, Texas, 77030, USA

    Paul F. Mansfield MD

Authors
  1. David L. Smith MD
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  2. Linda S. Elting DrPH
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  3. Peter A. Learn MD
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  4. Chandrajit P. Raut MD
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  5. Paul F. Mansfield MD
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Corresponding author

Correspondence to Paul F. Mansfield MD.

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Smith, D.L., Elting, L.S., Learn, P.A. et al. Factors Influencing the Volume-Outcome Relationship in Gastrectomies: A Population-Based Study. Ann Surg Oncol 14, 1846–1852 (2007). https://doi.org/10.1245/s10434-007-9381-0

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  • DOI: https://doi.org/10.1245/s10434-007-9381-0

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