Influence of hospital type on outcomes after oesophageal and gastric cancer surgery
British Journal of Surgery, 05/10/2012
Dikken JL et al. – Oesophagogastric resections performed in UH were associated with better outcomes but, owing to variation in outcomes within hospital types, centres of excellence cannot be designated solely on hospital type. Detailed information on case mix and outcomes is needed to identify centres of excellence.Methods
- Data were obtained from the nationwide Netherlands Cancer Registry. Hospitals were categorized as university hospitals (UH), non–university teaching hospitals (NUTH) and non–university non–teaching hospitals (NUNTH).
- Hospital type–outcome relationships were analysed by Cox regression, adjusting for case mix, hospital volume, year of diagnosis and use of multimodal therapies.
- Between 1989 and 2009, 10 025 oesophagectomies and 14 221 gastrectomies for cancer were performed in the Netherlands.
- The percentage of oesophagectomies and gastrectomies performed in UH increased from 17•6 and 6•4 per cent respectively in 1989 to 44•1 and 12•9 per cent in 2009.
- After oesophagectomy, the 3–month mortality rate was 2•5 per cent in UH, 4•4 per cent in NUTH and 4•1 per cent in NUNTH (P = 0•006 for UH versus NUTH).
- After gastrectomy, the 3–month mortality rate was 4•9 per cent in UH, 8•9 per cent in NUTH and 8•7 per cent in NUNTH (P < 0•001 for UH versus NUTH).
- Three–year survival was also higher in UH than in NUTH and NUNTH.