Surgical quality and health utilization of gastric cancer surgery in China: a post hoc analysis of the Prevalence of Abdominal Complications After Gastroenterological Surgery study.

OBJECTIVES

This study aimed to assess the surgical quality, safety, and healthcare utilization associated with gastric cancer surgery in China, using international studies for benchmarking.

DESIGN

A prospective registered study was conducted utilizing data from the Prevalence of Abdominal Complications After Gastroenterological Surgery study, comprised of 1859 patients without postoperative complications (non-POC group) and 412 patients with at least one POC group. Baseline characteristics, surgical outcomes, and healthcare utilization were compared between groups, and results were further contextualized through a review of international multicenter studies.

SETTING

20 centers across China, with data collected from December 2018 to December 2020.

PARTICIPANTS

2271 patients who underwent gastrectomy for gastric cancer, including 1859 in the non-POC group and 412 in the POC group.

MAIN OUTCOME MEASURES

POC incidence, postoperative hospital stay, healthcare costs, and cross-regional comparisons of surgical quality.

RESULTS

Patients with POCs exhibited distinct baseline and intraoperative profiles compared with those without. The most frequent complications were respiratory infections, anastomotic leakage, and non-leak intra-abdominal infections. Among surgical types, proximal gastrectomy had the highest POC incidence. Costs and postoperative hospital stay were significantly higher in patients with these complications. Compared with international cohorts, China demonstrated comparable surgical quality and complication profiles. However, the cost burden associated with major POCs was substantially lower in China, despite similar hospital stays.

CONCLUSION

China's gastric cancer surgery outcomes align with international standards in terms of surgical quality and complication rates. Notably, major complications were associated with significantly lower costs than those reported internationally, suggesting greater cost advantages in postoperative management. These findings highlight the value of robust complication reporting systems and evidence-based management protocols in delivering cost-effective, high-quality surgical care.

TRIAL REGISTRATION NUMBER

NCT03828266.