Relationship Between Volume and In-hospital Mortality in Digestive Oncological Surgery

Abstract

IntroductionThe results previously obtained in Spain in the study of the relationship between surgical caseload and in-hospital mortality are inconclusive. The aim of this study is to evaluate the volume–outcome association in Spain in the setting of digestive oncological surgery. MethodsAn analytical, cross-sectional study was conducted with data from patients who underwent surgical procedures with curative intent of esophageal, gastric, colorectal and pancreatic neoplasms between 2006 and 2009 with data from the Spanish MBDS. In-hospital mortality was used as outcome variable. Control variables were patient, health care and hospital characteristics. Exposure variable was the number of interventions for each disease, dividing the hospitals in 3 categories: high volume (HV), mid volume (MV) and low volume (LV) according to the number of procedures. ResultsAn inverse, statistically significant relationship between procedure volume and in-hospital mortality was observed for both volume categories in both gastric (LV: OR=1.50 [IC 95%: 1.28–1.76]; MV: OR=1.49 (IC 95%: 1.28–1.74)) and colorectal (LV: OR=1.44 [IC 95%: 1.33–1.55]; MV: OR=1.24 [IC 95%: 1.15–1.33]) cancer surgery. In pancreatic procedures, this difference was only statistically significant between LV and HV categories (LV: OR=1.89 [IC 95%: 1.29–2.75]; MV: OR=1.21 [IC 95%: 0.82–1.79]). Esophageal surgery also showed an inverse relationship, which was not statistically significant (LV: OR=1.89 [IC 95%: 0.98–3.64]; MV: OR=1.05 [IC 95%: 0.50–2.21]). ConclusionsThe results of this study suggest the existence in Spain of an inverse relationship between caseload and in-hospital mortality in digestive oncological surgery for the procedures analysed.