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Author:
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Baré, Marisa; Cabrol, Joan; Real, Jordi; Navarro, Gemma; Campo, Rafel; Pericay, Carles; Sarría, Antonio
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Notes:
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Background: There is no consensus about the possible relation between in-hospital mortality in
surgery for gastric cancer and the hospital annual volume of interventions. The objectives were to
identify factors associated to greater in-hospital mortality for surgery in gastric cancer and to
analyze the possible independent relation between hospital annual volume and in-hospital mortality.
Methods: We performed a retrospective cohort study of all patients discharged after surgery for
stomach cancer during 2001–2002 in four regions of Spain using the Minimum Basic Data Set for
Hospital Discharges. The overall and specific in-hospital mortality rates were estimated according
to patient and hospital characteristics. We adjusted a logistic regression model in order to calculate
the in-hospital mortality according to hospital volume.
Results: There were 3241 discharges in 144 hospitals. In-hospital mortality was 10.3% (95% CI
9.3–11.4). A statistically significant relation was observed among age, type of admission, volume,
and mortality, as well as diverse secondary diagnoses or the type of intervention. Hospital annual
volume was associated to Charlson score, type of admission, region, length of stay and number of
secondary diagnoses registered at discharge. In the adjusted model, increased age and urgent
admission were associated to increased in-hospital mortality. Likewise, partial gastrectomy (Billroth
I and II) and simple excision of lymphatic structure were associated with a lower probability of inhospital
mortality. No independent association was found between hospital volume and in-hospital
mortality
Conclusion: Despite the limitations of our study, our results corroborate the existence of patient,
clinical, and intervention factors associated to greater hospital mortality, although we found no
clear association between the volume of cases treated at a centre and hospital mortality. |
