More is better, when it comes to case volume, for complex ga
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A new study reinforces the principle that "practice makes perfect" when it comes to complex GI cancer operations. Patients whose procedures for gastrointestinal malignancies were performed by a surgical team at a hospital ranked as one of America's "best" by U.S. News & World Report (USNWR) were nearly two and half times more likely to survive the operation than those who had the same procedure done at an unranked hospital.

The objective of this study was to examine the outcomes of complex GI cancer resections performed at USNWR top-ranked, compared to non-ranked, hospitals.

Using the Vizient database, data for patients who underwent esophagectomy, gastrectomy, and pancreatectomy for malignancy were reviewed. Perioperative outcomes were analyzed according to USNWR rank status. The primary outcome was in-hospital mortality. Secondary outcomes include the length of stay, mortality index (observed-to-expected mortality ratio), rate of serious complication, and cost.

There were 3054 complex GI cancer resections performed at 42 top-ranked hospitals vs 3608 resections performed at 198 non-ranked hospitals.

--The mean annual case volume was 73 cases at top-ranked hospitals compared to 18 cases at non-ranked hospitals.

--Compared with non-ranked hospitals, top-ranked hospitals had lower in-hospital mortality and lower mortality index.

--There were no significant differences in length of stay, rate of serious complications, or direct cost between groups.

--In patients who developed serious morbidity, top-ranked hospitals had lower mortality compared with non-ranked hospitals.

Conclusively, within the context of complex GI cancer resection, USNWR top-ranked hospitals performed a 4-fold higher case volume and were associated with improved outcomes. Patients with complex GI-related malignancies may benefit from seeking surgical care at high-volume regional USNWR top-ranked hospitals.

JACS
Source: https://doi.org/10.1016/j.jamcollsurg.2021.02.012
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