Overall Volume Trends in Esophageal Cancer Surgery Results From the Dutch Upper Gastrointestinal Cancer Audit.
Ann Surg
; 274(3): 449-458, 2021 09 01.
Article
em En
| MEDLINE
| ID: mdl-34397452
ABSTRACT
OBJECTIVE:
In the pursuit of quality improvement, this study aimed to investigate volume-outcome trends in oncologic esophagectomy in the Netherlands. SUMMARY OF BACKGROUND DATA Concentration of Dutch esophageal cancer care was dictated by introducing an institutional minimum of 20âresections/yr.METHODS:
This nationwide cohort study included all esophagectomy patients registered in the Dutch Upper Gastrointestinal Cancer Audit in 2016-2019 from hospitals currently still performing esophagectomies. Annual esophagectomy hospital volume was assigned to each patient and categorized into quartiles. Multivariable logistic regression investigated short-term surgical outcomes. Restricted cubic splines investigated if volume-outcome relationships eventually plateaued.RESULTS:
In 16 hospitals, 3135 esophagectomies were performed. First volume quartile hospitals performed 24-39âresections/yr; second, third, and fourth quartile hospitals performed 40-53, 54-69, and 70-101, respectively. Compared to quartile 1, in quartiles 2 to 4, overall/severe/technical complication, anastomotic leakage, and prolonged hospital/intensive care unit stay rates were significantly lower and textbook outcome and lymph node yield were higher. When raising the cut-off from the first to second quartile, higher-volume centers had less technical complications [Adjusted odds ratio (aOR) 0.82, 95% confidence interval (CI) 0.70-0.96], less anastomotic leakage (aOR 0.80, 95% CI 0.66-0.97), more textbook outcome (aOR 1.25, 95% CI 1.07-1.46), shorter intensive care unit stay (aOR 0.80, 95% CI 0.69-0.93), and higher lymph node yield (aOR 3.56, 95% CI 2.68-4.77). For most outcomes the volume-outcome trend plateaued at 50-60 annual resections, but lymph node yield and anastomotic leakage continued to improve.CONCLUSION:
Although this study does not reflect on individual hospital quality, there appears to be a volume trend towards better outcomes in high-volume centers. Projects have been initiated to improve national quality of care by reducing hospital variation (irrespective of volume) in outcomes in The Netherlands.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Padrões de Prática Médica
/
Neoplasias Esofágicas
/
Esofagectomia
/
Hospitais com Alto Volume de Atendimentos
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Holanda