Relationship between volume and in-hospital mortality in digestive oncological surgery.

ABSTRACT

INTRODUCTION: The results previously obtained in Spain in the study of the relationship between surgical caseload and in-hospital mortality are inconclusive. The aim of this study is to evaluate the volume-outcome association in Spain in the setting of digestive oncological surgery. METHODS: An analytical, cross-sectional study was conducted with data from patients who underwent surgical procedures with curative intent of esophageal, gastric, colorectal and pancreatic neoplasms between 2006-2009 with data from the Spanish MBDS. In-hospital mortality was used as outcome variable. Control variables were patient, health care and hospital characteristics. Exposure variable was the number of interventions for each disease, dividing the hospitals in 3 categories high volume (HV), mid volume (MV) and low volume (LV) according to the number of procedures. RESULTS: An inverse, statistically significant relationship between procedure volume and in-hospital mortality was observed for both volume categories in both gastric (LV OR=1,50 [IC 95% 1,28-1,76]; MV OR=1,49 (IC 95% 1,28-1,74)) and colorectal (LV OR=1,44 [IC 95% 1,33-1,55]; MV OR=1,24 [IC 95% 1,15-1,33]) cancer surgery. In pancreatic procedures, this difference was only statistically significant between LV and HV categories (LV OR=1,89 [IC 95% 1,29-2,75]; MV OR=1,21 [IC 95% 0,82-1,79]). Esophageal surgery also showed an inverse relationship, which was not statistically significant (LV OR=1,89 [IC 95% 0,98-3,64]; MV OR=1,05 [IC 95% 0,50-2,21]). CONCLUSIONS: The results of this study suggest the existence in Spain of an inverse relationship between caseload and in-hospital mortality in digestive oncological surgery for the procedures analyzed.