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No association between hospital volume and short-term outcomes of some common surgeries: a retrospective cohort study based on a Japanese nationwide database

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Abstract

Purpose

Centralization of high-risk surgeries has become a widespread strategy. However, whether or not the hospital volume affects the outcomes of common surgeries remains unclear. This study explored the association between hospital volume and short-term outcomes of common surgeries, as represented by appendectomy, cholecystectomy, and pneumothorax surgery, by analyzing data from a Japanese nationwide database.

Methods

All hospitals were categorized into four groups (very low-, low-, high-, and very high-volume) according to the annual hospital volume of all gastrointestinal surgeries or all respiratory surgeries in 2017. Patient demographic data and surgical outcomes were evaluated across hospital volume categories.

Results

We analyzed 2392 facilities which performed 771,182 gastrointestinal surgeries, and 992 facilities which performed 98,656 respiratory surgeries. Short-term outcomes of patients who underwent appendectomy (n = 50,568), cholecystectomy (n = 104,262), and pneumothorax surgery (n = 11,723) were evaluated. The incidences of postoperative complications, reoperation, and readmission were similar among the groups. Multivariable logistic regression analyses revealed hospital volume to have no association with these short-term outcomes.

Conclusion

Analyses of a Japanese nationwide database revealed that the hospital volume was not associated with short-term outcomes of appendectomy, cholecystectomy, and pneumothorax surgery. These common surgical procedures may not require centralization into high-volume hospitals.

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Acknowledgements

The authors thank all of the data managers and hospitals participating in this NCD project for their invaluable efforts in entering the data analyzed in this study.

Funding

This work was supported by The Health Science and Labor Research Grants (HSLRG).

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kota Itamoto, Susumu Aikou, Koichi Yagi, Hiroharu Yamashita, Sachiyo Nomura & Yasuyuki Seto

  2. Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan

    Hiraku Kumamaru & Hiroaki Miyata

  3. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Shinji Kuroda & Toshiyoshi Fujiwara

  4. The Japanese Association for Chest Surgery, Tokyo, Japan

    Shunsuke Endo

  5. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yuko Kitagawa

  6. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yoshihiro Kakeji

Authors
  1. Kota Itamoto
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  2. Hiraku Kumamaru
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  3. Susumu Aikou
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  7. Hiroaki Miyata
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  9. Toshiyoshi Fujiwara
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  10. Shunsuke Endo
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  11. Yuko Kitagawa
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  12. Yoshihiro Kakeji
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  13. Yasuyuki Seto
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Contributions

Drs. Kota Itamoto, Hiraku Kumamaru, Susumu Aikou, Koichi Yagi, Hiroharu Yamashita, Sachiyo Nomura, Hiroaki Miyata, Shinji Kuroda, Toshiyoshi Fujiwara, Shunsuke Endo, Yuko Kitagawa, Yoshihiro Kakeji, and Yasuyuki Seto meet all of the criteria of the International Committee of Medical Journal Editors (ICMJE).

Corresponding author

Correspondence to Yasuyuki Seto.

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Conflict of interest

KI, HK, SA, KY, HY, SN, HM, SK, TF, SE, YK, YK, and YS have no conflicts of interest or financial ties to disclose regarding the submitted work.

Ethical approval

All procedures followed in this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1964 Declaration of Helsinki and later versions. The Institutional Review Board of the University of Tokyo Hospital approved this study (2019033NI).

Informed consent

Informed consent for this analysis was based on the informed opt-out procedure because of the retrospective nature of the study and anonymous clinical data were used for the analysis.

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Itamoto, K., Kumamaru, H., Aikou, S. et al. No association between hospital volume and short-term outcomes of some common surgeries: a retrospective cohort study based on a Japanese nationwide database. Surg Today 52, 941–952 (2022). https://doi.org/10.1007/s00595-022-02467-x

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  • DOI: https://doi.org/10.1007/s00595-022-02467-x

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