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Mortality after esophagectomy is heavily impacted by center volume: retrospective analysis of the Nationwide Inpatient Sample

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Abstract

Background

The effects of hospital volume on in-hospital mortality after esophageal resection are disputed in the literature. We sought to analyze treatment effects in patient subpopulations that undergo esophagectomy for cancer based on hospital volume.

Methods

We performed a retrospective analysis of the Nationwide Inpatient Sample from 1998 to 2011. Patients who underwent open or laparoscopic transhiatal and transthoracic esophageal resection were identified using ICD-9 codes. Patients <18 years and those with peritoneal disease were excluded. Multivariate logistic regression analyses were used with mortality as the independent variable to evaluate the effect of low (<6), intermediate (6–19), and high (≥20) hospital volume of esophagectomies. These analyses were repeated in different subsets of patients to determine whether hospital volume affected mortality depending on the subpopulation evaluated. Subgroups were created depending on age, race, gender, operative approach, comorbidities, and tumor pathology.

Results

A total of 23,751 patients were included. The overall perioperative mortality rate was 7.7 % (low volume: 11.4 %; intermediate volume: 8.39 %, high volume: 4.01 %), and multivariate analysis revealed that high hospital volume had a protective effect (OR 0.54, 95 % CI 0.45–0.65). On subgroup analyses for low- and intermediate-volume hospitals, mortality was uniformly elevated for the subpopulations when comparing to high-volume hospitals (p < 0.05). There was no difference in mortality between low- and medium-volume hospitals and between subgroups.

Conclusion

No lower mortality risk subgroup could be identified in this nationwide collective. This analysis emphasizes that perioperative mortality after esophagectomy for cancer is lower in high-volume hospitals.

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Author notes

    Authors and Affiliations

    1. Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA

      Hans F. Fuchs, Cristina R. Harnsberger, Ryan C. Broderick, Bryan J. Sandler, Garth R. Jacobsen & Santiago Horgan

    2. Department of General Surgery, University of Cologne, Cologne, Germany

      Hans F. Fuchs

    3. Department of Surgery, University of California, San Diego, La Jolla, CA, USA

      David C. Chang

    4. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

      David C. Chang

    5. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, La Jolla, CA, USA

      Michael Bouvet

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    1. Hans F. Fuchs
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    Correspondence to Hans F. Fuchs.

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    Drs. Fuchs, Harnsberger, Broderick, Chang, Sandler, Jacobsen, Bouvet, and Horgan have no conflicts of interest or financial ties to disclose.

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    Hans F. Fuchs and Cristina R. Harnsberger have contributed equally to this work.

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    Fuchs, H.F., Harnsberger, C.R., Broderick, R.C. et al. Mortality after esophagectomy is heavily impacted by center volume: retrospective analysis of the Nationwide Inpatient Sample. Surg Endosc 31, 2491–2497 (2017). https://doi.org/10.1007/s00464-016-5251-9

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