Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004-2008.


Coupland, VH; Lagergren, J; Lüchtenborg, M; Jack, RH; Allum, W; Holmberg, L; Hanna, GB; Pearce, N; Møller, H; (2012) Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004-2008. Gut. ISSN 0017-5749 DOI: https://doi.org/10.1136/gutjnl-2012-303008

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Abstract

OBJECTIVE: This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England. DESIGN: 62 811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery: <30, 30-365, and >365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients. RESULTS: Increasing hospital volume was associated with lower mortality (p(trend)=0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with <20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (p(trend)<0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (p(trend)=0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (p(trend)<0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile). CONCLUSIONS: With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 23086798
Web of Science ID: 319975900004
URI: http://researchonline.lshtm.ac.uk/id/eprint/620236

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