Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, Medical Centre Julius Maximilians, University of Würzburg, Oberdurrbacherstrasse 6, 97080, Würzburg, Germany.
Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany.
Gastric Cancer. 2021 Jul;24(4):959-969. doi: 10.1007/s10120-021-01167-8. Epub 2021 Feb 12.
For many cancer resections, a hospital volume-outcome relationship exists. The data regarding gastric cancer resection-especially in the western hemisphere-are ambiguous. This study analyzes the impact of gastric cancer surgery caseload per hospital on postoperative mortality and failure to rescue in Germany.
All patients diagnosed with gastric cancer from 2009 to 2017 who underwent gastric resection were identified from nation-wide administrative data. Hospitals were grouped into five equal caseload quintiles (I-V in ascending caseload order). Postoperative deaths and failure to rescue were determined.
Forty-six thousand one hundred eighty-seven patients were identified. There was a significant shift from partial resections in low-volume hospitals to more extended resections in high-volume centers. The overall in-house mortality rate was 6.2%. The crude in-hospital mortality rate ranged from 7.9% in quintile I to 4.4% in quintile V, with a significant trend between volume categories (p < 0.001). In the multivariable logistic regression analysis, quintile V hospitals (average of 29 interventions/year) had a risk-adjusted odds ratio of 0.50 (95% CI 0.39-0.65), compared to the baseline in-house mortality rate in quintile I (on average 1.5 interventions/year) (p < 0.001). In an analysis only evaluating hospitals with more than 30 resections per year mortality dropped below 4%. The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue (FtR) decreased significantly with increasing caseload.
Patients who had gastric cancer surgery in hospitals with higher volume had better outcomes and a reduced failure to rescue rates for severe complications.
对于许多癌症切除术，存在医院量效关系。关于胃癌切除术的数据 - 特别是在西半球 - 尚不清楚。本研究分析了德国每所医院胃癌手术量对术后死亡率和抢救失败的影响。
从全国行政数据中确定了 2009 年至 2017 年间诊断为胃癌并接受胃切除术的所有患者。将医院分为五个相等的病例量五分位数（按病例量递增顺序分为 I-V 五分位数）。确定术后死亡和抢救失败的情况。
确定了 46187 名患者。低容量医院的部分切除术明显转向高容量中心的更广泛切除术。总体院内死亡率为 6.2%。住院死亡率的粗率从五分位数 I 的 7.9%到五分位数 V 的 4.4%，呈明显的量分类趋势（p<0.001）。在多变量逻辑回归分析中，五分位数 V 医院（平均 29 次干预/年）的风险调整比值比为 0.50（95%CI 0.39-0.65），与五分位数 I 的基线院内死亡率（平均 1.5 次干预/年）相比（p<0.001）。仅在分析每年进行超过 30 次切除术的医院时，死亡率降至 4%以下。不同病例量五分位数之间的总术后并发症发生率相当，但抢救失败（FtR）随着病例量的增加而显著下降。
在手术量较大的医院接受胃癌手术的患者有更好的结局，并且严重并发症的抢救失败率降低。
