Surgeon density and its effect on esophageal (EC) and gastric cancer (GC) mortality.

Abstract

e16548 Background: Surgical resection plays an integral role in the curative treatment of patients with EC and GC. The impact of the allocation of these surgeons at the county level on cancer outcomes is unclear. Our aims were to 1) examine the effect of surgeon density on EC and GC mortality, 2) compare the relative roles of thoracic and general surgeons on EC and GC outcomes and 3) determine county characteristics associated with cancer mortality. Methods: Using county-level data from the Area Resources File, US Census and National Cancer Institute, we constructed linear regression models to explore the effect of thoracic and general surgeon density on EC and GC mortality, respectively. Multivariate analyses adjusted for cancer incidence rate, county-level demographics (population aged 65+, proportion eligible for Medicare, education attainment, metropolitan vs. rural area, ethnicity), socioeconomic factors (median household income) and healthcare resources (number of general practitioners, availability of hospital beds). Results: In total, 663 and 539 counties were analyzed for EC and GC, respectively: mean EC/GC incidence = 5.53/6.86; mean EC/GC mortality = 4.95/4.07; 76% and 85% were metropolitan for EC and GC, respectively; mean thoracic and general surgeon densities were 6 and 50 per 100,000 people, respectively. When compared to counties with no thoracic surgeons, those with at least 1 thoracic surgeon had reduced EC mortality (beta coefficient -0.34). For GC, counties with 1 or more general surgeons also had decreased number of deaths (beta coefficient -0.125) when compared with those without any surgeons. While increasing the density of surgeons beyond 10 only yielded minimal improvements in EC mortality, it resulted in significant further reductions in GC mortality. Other county characteristics, such as increased number of hospital beds and higher median household income, were correlated with improved outcomes. Conclusions: Mortality from GC appears to be more susceptible to the benefits of increased surgeon density. For EC, a strategic policy of allocating health resources and distributing the workforce across counties will be best able to optimize outcomes at the population-level.