Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers
- 1 July 2002
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 89 (7), 914-922
- https://doi.org/10.1046/j.1365-2168.2002.02135.x
Abstract
Background To evaluate specialization in National Health Service (NHS) cancer care, volume–outcome relationships were examined. Methods This was a cohort study of 1512 patients with oesophageal or gastric cancer in 23 acute NHS hospitals. Outcomes were survival time and operative (30 day) mortality. Multiple regression analysis was performed, adjusted for diagnoses, prognoses and treatments. Results For oesophageal cancer, the operative mortality rate decreased by 40 per cent (odds ratio 0·60 (95 per cent confidence interval (c.i.) 0·36 to 0·99 per cent); P = 0·047) for each increase of ten patients in doctors' annual surgical caseloads, and the risk of death decreased by 8 per cent (hazard ratio 0·92 (95 per cent c.i. 0·85 to 0·99); P = 0·021) for each increase of ten patients in doctors' annual caseloads. For gastric cancer, the operative mortality rate decreased by 41 per cent (odds ratio 0·59 (95 per cent c.i. 0·32 to 1·07)) for each increase of ten patients in doctors' annual surgical caseloads, and the risk of death decreased by 7 per cent (hazard ratio 0·93 (95 per cent c.i. 0·89 to 0·98); P = 0·009) for each increase of ten patients in hospitals' annual caseloads. Patients of higher-volume doctors were more likely to receive most investigations and treatments, independently of presenting features. Conclusion The study supports concentration of services for oesophageal and gastric cancers. Specialization of doctors and their teams is at least as important as specialization of hospitals.Keywords
This publication has 23 references indexed in Scilit:
- One-year survey of carcinoma of the oesophagus and stomach in WalesBritish Journal of Surgery, 2001
- Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancerThe Journal of Thoracic and Cardiovascular Surgery, 2000
- Effect of surgical experience on results of esophagectomy for esophageal carcinomaJournal of Surgical Oncology, 1997
- Management of malignant teratoma: does referral to a specialist unit matter?The Lancet, 1993
- Selection for oesophagectomy and postoperative outcome in a defined population.Quality and Safety in Health Care, 1993
- Improving survival in gastric cancer: Review of 5-year survival rates in English language publications from 1970British Journal of Surgery, 1992
- Improving survival in gastric cancer: Review of operative mortality in english language publications from 1970British Journal of Surgery, 1991
- Medical audit, cancer registration, and survival in ovarian cancerThe Lancet, 1991
- Physician and Hospital Factors Associated With Mortality of Surgical PatientsMedical Care, 1986
- Adenocarcinoma of the oesophagus and of the oesophagogastric junctionBritish Journal of Surgery, 1978