Correlation Between the Increased Hospital Volume and Decreased Overall Perioperative Mortality in One Universal Health Care System

  • Jin-Ming Wu
  • Te-Wei HoEmail author
  • Yu-Wen TienEmail author
Original Scientific Report



Volume–outcome relationship has been demonstrated extensively for short-term outcomes for oncological surgery. However, its effect on long-term surgical outcomes or in one universal health care (UHC) system is unknown. This retrospective population-based study aims to validate the correlation between the increased hospital volume and better short- and long-term outcomes in patients who underwent total gastrectomy (TG) for gastric cancer.


From the Taiwan National Health Insurance Research Database, we examined 7905 patients who underwent TG between 2000 and 2010. The surgical outcomes of this study were defined as death within 30, 60, and 180 days after TG.


A total of 7905 subjects were included for analysis. The mean age was 65.8 years, and 68.8% were males. The 30-, 60-, and 180-day mortality rates after TG for gastric cancer were 2.7%, 6.2%, and 18.2%, respectively. On the multivariate analysis, TG at high-volume hospitals significantly contributed to lower 30-day (odds ratio 0.64; 95% confidence interval 0.48–0.85; P < 0.001), 60-day (odds ratio 0.68; 95% confidence interval 0.56–0.82; P < 0.001), and 180-day mortality rates (odds ratio 0.80; 95% confidence interval 0.70–0.90; P < 0.001).


Although TG is a complex operation with high mortality rates (~180-day), high hospital volume correlates with better perioperative outcomes even in UHC system. Hence, the strategy to advocate the centralization of TG is reasonable, especially for the elderly.



Total gastrectomy


Confidence interval


Diabetes mellitus


National Health Insurance Research Database


International Classification of Disease, Ninth Revision, Clinical Modification



This study is based on data from the Collaboration Center of Health Information Application of the Ministry of Health and Welfare, which had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study was supported by Grants from the Ministry of Science and Technology, Taiwan (MOST 105-2221-E-002-192 & 107-2634-F-002-015), and from the National Taiwan University Hospital (105-N3315).

Supplementary material

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Supplementary material 1 (DOCX 18 kb)


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of Surgery, National Taiwan University Hospital and College of MedicineNational Taiwan UniversityTaipeiTaiwan, ROC

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