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Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial

Authors: Claassen, Y H M; van Sandick, J W; Hartgrink, H H; Dikken, J L; De Steur, W O; van Grieken, N C T; Boot, H; +9 Authors

Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial

Abstract

Abstract Background Studies investigating the association between hospital volume and quality of gastric cancer surgery are lacking. In the present study, the effect of hospital volume on quality of gastric cancer surgery was evaluated by analysing data from the CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial. Methods Patients who underwent gastrectomy with curative intent in the Netherlands were selected from the CRITICS trial database. Annual hospital volume of participating centres was derived from the Netherlands Cancer Registry. Hospital volume was categorized into very low (1–10 gastrectomies per year per institution), low (11–20), medium (21–30) and high (31 or more), and linked to the CRITICS database. Quality of surgery was analysed by surgicopathological compliance (removal of at least 15 lymph nodes), surgical compliance (removal of indicated lymph node stations) and the Maruyama Index. Postoperative morbidity and mortality were also compared between hospital categories. Results Between 2007 and 2015, 788 patients were included in the CRITICS study, of whom 494 were analysed. Surgicopathological compliance was higher (86·7 versus 50·4 per cent; P < 0·001), surgical compliance was greater (52·9 versus 19·8 per cent; P < 0·001) and median Maruyama Index was lower (0 versus 6; P = 0·006) in high-volume hospitals compared with very low-volume hospitals. There was no statistically significant difference in postoperative complications or mortality between the hospital volume categories. Conclusion Surgery performed in high-volume hospitals was associated with better surgical quality than surgery carried out in lower-volume hospitals.

Country
Netherlands
Keywords

Postoperative Complications/epidemiology, Adult, Male, Netherlands/epidemiology, Adenocarcinoma, Stomach Neoplasms/mortality, Postoperative Complications, Gastrectomy, Stomach Neoplasms, Hospitals/standards, Humans, Registries, Gastrectomy/standards, Aged, Netherlands, Quality Indicators, Health Care, Quality of Health Care, Aged, 80 and over, Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences, Middle Aged, Quality of Health Care/organization & administration, Hospitals, Adenocarcinoma/mortality, Radiation Oncology - Radboud University Medical Center, Lymph Node Excision, Lymph Node Excision/statistics & numerical data, Female

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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
43
Top 10%
Top 10%
Top 10%
hybrid