Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system
Despite interest in surgeon and hospital volume effects on distal gastrectomy, clinical significance has not been confirmed in a large-scale population. We studied to clarify the effects of surgeon and hospital volume on postoperative mortality after distal gastrectomy for gastric cancer among Japanese patients in a nationwide web-based data entry system.
We extracted data on distal gastrectomy for gastric cancer from the National Clinical Database between 2011 and 2015. The primary outcome was operative mortality. Hospital volume was divided into 3 tertiles: low (1–22 cases per year), medium (23–51) and high (52–404). Surgeon volume was divided into the 5 groups: 0–3, 4–10, 11–20, 21–50, 51 + cases per year. We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (ORs) estimated from a hierarchical logistic regression model.
We analyzed 145,523 patients at 2182 institutions. Operative mortality was 1.9% in low-, 1.0% in medium- and 0.5% in high-volume hospitals. The operative mortality rate decreased definitively with surgeon volume, 1.6% in the 0–3 group and 0.3% in the 51 + group. After risk adjustment for surgeon and hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (medium: OR 0.64, 95% CI 0.56–0.73, P < 0.001; high: OR 0.42, 95% CI 0.35–0.51, P < 0.001).
We demonstrate that hospital volume can have a crucial impact on postoperative mortality after distal gastrectomy compared with surgeon volume in a nationwide population study. These findings suggest that centralization may improve outcomes after distal gastrectomy.
KeywordsGastric cancer Distal gastrectomy Hospital volume
The authors thank all of the data managers and hospitals participating in this NCD project for their great efforts in entering the data analyzed in this study. The authors also thank Prof Hideki Hashimoto and Noboru Motomura, MD, for providing direction for the foundation of the NCD and the working members of the JSGS database committee (Harushi Udagawa, MD; Michiaki Unno, MD; Itaru Endo, MD; Chikara Kunisaki, MD; Akinobu Taketomi, MD; Akira Tangoku, MD; Tadahiko Masaki, MD; Shigeru Maruhashi, MD; Kazuhiro Yoshida, MD). The authors also thank Hiroyuki Konno, MD, for his important suggestions regarding this article. This work was supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science, grant number 16K10463 (For M.I.).
None of these organizations had any role in the design and conduct of the study, data collection, data analysis, data management, data interpretation, or the preparation, review, and approval of this manuscript. This work was supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science, grant number 16K10463 (For M.I.).
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Conflict of interest
Hiroaki Miyata and Hiroyuki Yamamoto are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., and Nipro Co.
- 11.Mahmoudi E, Lu Y, Chang SC, Lin CY, Wang YC, Chang CJ, et al. The associations of hospital volume, surgeon volume, and surgeon experience with complications and 30-day rehospitalization after free tissue transfer: a national population study. Plast Reconstr Surg. 2017;140(2):403–11.CrossRefGoogle Scholar
- 27.Jensen LS, Nielsen H, Mortensen PB, Pilegaard HK, Johnsen SP. Enforcing centralization for gastric cancer in Denmark. Eur J Surg Oncol. 2010;36(Suppl 1):50-4.Google Scholar