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Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004-2008
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2013 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 62, no 7, 961-966 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2013. Vol. 62, no 7, 961-966 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-187278DOI: 10.1136/gutjnl-2012-303008ISI: 000319975900004PubMedID: 23086798OAI: oai:DiVA.org:uu-187278DiVA: diva2:574120
Available from: 2012-12-04 Created: 2012-12-04 Last updated: 2017-12-07Bibliographically approved

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Holmberg, Lars

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