Year 2017 / Volume 109 / Number 9
Original
Towards the centralization of digestive oncologic surgery: changes in activity, techniques and outcome

634-642

DOI: 10.17235/reed.2017.4710/2016

Cristian Tebé, Roger Pla, Josep Alfons Espinàs, Julieta Corral, Elisa Puigdomenech, Josep Maria Borràs, Joan M. V. Pons, Mireia Espallargues,

Abstract
Aim: The objective of the present study was to examine changes in the activity, surgical techniques and results from the process of centralization of complex digestive oncologic surgery in 2005-2012 as compared to 1996-2000. Material and methods: A retrospective cohort study employing the minimum basic data set of hospital discharge (MBDSHD 1996-2012) from public centers in Catalonia (Spain) was performed. The population consisted of individuals aged > 18 who underwent digestive oncologic surgery (esophagus, pancreas, liver, stomach or rectum). Medical centers were divided into low, medium, and high-volume centers (≤ 5, 6-10, and > 10 interventions/year, respectively). The tendency Chi-squared test was used to assess the centralization of patients in high-volume centers and hospital mortality evolution during the study period. Logistic regression was performed to assess the relationship between volume and outcome. Results: A centralization of complex oncologic digestive surgery between 10% (liver) and 46% (esophagus) was obtained by means of a reduction in the number of hospitals that perform these interventions and a significant rise in the number of patients operated in high-volume centers (all types p ≤ 0.0001, except for esophagus). A significant decrease in mortality was observed, especially in esophagus (from 15% in 1996/2000 to 7% in 2009/12, p = 0.003) and pancreas (from 12% in 1996/2000 to 6% in 2009/12, p trend < 0.0001). Conclusions: A centralization of oncologic digestive surgery in high-volume centers and a reduction of hospital mortality in Catalonia were reported among esophageal and pancreatic cancers. However, no significant changes were found for others cancer types.
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References
1. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301(25):1364-9.
2. Ghaferi AA, Birkmeyer JD, Dimick JBB. Variation in Hospital Mortality Associated with Inpatient Surgery. N Engl J Med. 2009;361(14):1368-75.
3. Donabedian A. The Quality of Care. How Can It Be Assessed? JAMA. 1988;260(12):1743-8.
4. Iezzoni LI. The risks of risk adjustment. JAMA. 1997;278(19):1600-7.
5. Tekkis PP, McCulloch P, Steger AC, Benjamin IS, Poloniecki JD. Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data. BMJ. 2003;326(7393):786-8.
6. Walker K, Neuburger J, Groene O, Cromwell DA, van der Meulen J. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. Lancet. 2013;382(9905):1674-7.
7. Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777-83.
8. Pieper D, Mathes T, Neugebauer E, Eikermann M. State of Evidence on the Relationship between High-Volume Hospitals and Outcomes in Surgery: A Systematic Review of Systematic Reviews. J Am Coll Surg. 2013;216(5):1015-1025.e18.
9. Pérez-López, Baré M, Touma-Fernández, Sarría-Santamera. Relationship Between Volume and In-hospital Mortality in Digestive Oncological Surgery. Cir Esp. 2016 Mar;94(3):151-158
10. Khuri SF, Henderson WG. The case against volume as a measure of quality of surgical care. World J Surg. 2005;29(10):1222-9
11. Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care. 2011;49(12):1076-81
12. Observatori del Sistema de Salut de Catalunya. Central de Resultats del sistema sanitari integral d’utilització pública de Catalunya. Barcelona: Agència de Qualitat i Aval•luació Sanitàries de Catalunya. Departament de Salut. Generalitat de Catalunya. Disponible en: http://observatorisalut.gencat.cat/ca/central_de_resultats
13. Pla R, Pons JMV, González JR, Borràs JM. Does volume influence outcome in cancer surgery? Analysis based on clinical-administrative data. Cir Esp. 2004;75(4):179-88.
14. Díaz de Tuesta I, Cuenca J, Fresneda PC, Calleja M, Llorens R, Aldámiz G, et al. No hay relación entre el volumen quirúrgico y la mortalidad en los servicios de cirugía cardiaca en España. Rev Esp Cardiol. 2008 Mar;61(3):276–82.
15. Baré M, Cabrol J, Real J, Navarro G, Campo R, Pericay C, et al. In-hospital mortality after stomach cancer surgery in Spain and relationship with hospital volume of interventions. BMC Public Health. 2009;9:312.
16. Gooiker GA, van Gijn W, Wouters MWJM, Post PN, van de Velde CJH, Tollenaar R a. EM, et al. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg. 2011 Apr;98(4):485–94.
17. Lauder CIW, Marlow NE, Maddern GJ, Barraclough B, Collier NA, Dickinson IC, et al. Systematic review of the impact of volume of oesophagectomy on patient outcome. ANZ J Surg. 2010 May;80(5):317–23.
18. Espallargues M, Almazán C, Tebé C, Pla R, Pons JMV, Sánchez E, et al. Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study. Rev Esp Enferm Dig. 2009;101(10):680-96.
19. Smith TJ, Hillner BE, Bear HD. Taking action on the volume-quality relationship: how long can we hide our heads in the colostomy bag? J Natl Cancer Inst. 2003;95(10):695-7.
20. CatSalut. Instrucció 01/2012, de 3 de gener de 2012, de reordenació de l'atenció oncològica d'alta especialització. Barcelona: CatSalut. Servei Català de la Salut. Departament de Salut. Generalitat de Catalunya
21. Librero J, Cuenca C, Peiró S. Comorbilidad e índice de Charlson: cálculo y aplicaciones en el CMBD. València: Quaderns de Salut Pública i Administració de Serveis de Salut. Escola Valenciana d'Estudis per a la Salut; 2002
22. Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference?: A follow-up analysis of another decade. Ann Surg. 2009;250(3):472-83.
23. Colavita PD, Tsirline VB, Belyansky I, Swan RZ, Walters AL, Lincourt AE, Iannitti DA et al. Regionalization and outcomes of hepato-pancreato-biliary cancer surgery in USA. J Gastrointest Surg. 2014;18(3):532-41
24. Steele RJ. The influence of surgeon case volume on outcome in site-specific cancer surgery. Eur J Surg Oncol. 1996;22(3):211-3
25. Curry LA, Spatz E, Cherlin E, Thompson JW, Berg D, Ting HH, et al. What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study. Ann Intern Med. 2011;154(6):384-90.
26. Auerbach AD, Maselli J, Carter J, Pekow PS, Lindenauer PK. The Relationship between Case-Volume, Care Quality, and Outcomes of Complex Cancer Surgery. J Am Coll Surg. 2010;211(5):601-8.
27. Tol JA, van Gulik TM, Busch OR, Gouma DJ. Centralization of Highly Complex Low-Volume Procedures in Upper Gastrointestinal Surgery. A Summary of Systematic Reviews and Meta-Analyses. Dig Surg. 2012;29:374-83.
28. Birkmeyer JD, Dimick JB. Understanding and reducing variation in surgical mortality. Annu Rev Med. 2009;60:405-15.
29. van der Leeuw RM, Lombarts KM, Arah OA, Heineman MJ. A systematic review of the effects of residency training on patient outcomes. BMC Med. 2012;10:65.
30. Clark W, Hernandez J, McKeon BA, Kahn A, Morton C, Toomey P, et al. Surgery residency training programmes have greater impact on outcomes after pancreaticoduodenectomy than hospital volume or surgeon frequency. HPB (Oxford). 2010;12(1):68-72.
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Tebé C, Pla R, Espinàs J, Corral J, Puigdomenech E, Borràs J, et all. Towards the centralization of digestive oncologic surgery: changes in activity, techniques and outcome. 4710/2016


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Publication history

Received: 04/11/2016

Accepted: 17/03/2017

Online First: 27/07/2017

Published: 31/08/2017

Article revision time: 99 days

Article Online First time: 265 days

Article editing time: 300 days


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