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| |  Oesophagectomy Outcomes Superior in High-Volume Centres: Presented at SSO By Jill Stein ST. LOUIS, Mo -- March 7, 2010 -- Patients in Florida who require an oesophagectomy will likely do better if they undergo the procedure at a high-volume surgical centre, researchers said here on March 6 at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO). Their results, from the largest population-based study to date for oesophagectomy in Florida, reveal that outcomes are better if the procedure is performed at a high-volume centre. Kfir Ben-David, MD, University of Florida College of Medicine, Gainesville, Florida, and colleagues analysed outcomes for oesophagectomy performed in Florida from 1997 through 2006 using a large healthcare database. “The increasing incidence of oesophageal cancer in the United States and elsewhere coupled with the curability of early-stage disease mandates that oesophagectomy be done in centres with low morbidity and mortality,” the authors wrote in their poster presentation. “However, oesophagectomy has been associated with substantial morbidity and mortality and, as with many complex procedures, volume is an important determinant of quality of care.” Thus, it is likely that referral of patients with oesophageal cancer to surgical centres with appropriate volume improves quality of care. For this reason, the research team decided to determine variations in outcome across the state of Florida for oesophagectomy in high -and low-volume regions. They calculated the frequency of oesophagectomy, length of hospital stay, and leak complication rate, and determined the risk-adjusted mortality for the procedure in low- volume and high-volume regions in the state with adjustment for race, gender, age, principal payer, diagnosed related group, and comorbidities. High-volume centres were defined as centres performing at least 12 resections a year, while low-volume centres performed fewer than 12 resections annually. Overall, 991 oesophagectomies were performed during the 10-year study period, and the incidence of oesophagectomy was significantly higher in 2002 through 2006 compared with 1997 through 2001. Results showed that the risk-adjusted postoperative mortality was significantly lower (odds ratio, 0.54) in high-volume regions (5.1% for high-volume vs 10.4% for low-volume regions). However, the difference in risk-adjusted postoperative mortality was not due to a difference in anastomotic leak rates, which occurred in 8.2% of patients in both high- and low-volume regions. The length of hospital stay tended to be shorter in high-volume regions. Overall, the results demonstrate that oesophagectomy-related mortality and length of stay are decreased in high-volume regions performing at least 12 oesophagectomies a year. Regionalisation of oesophagectomy to high-volume locations in Florida can potentially decrease procedure-related mortality, length of hospital stay, and total charges. [Presentation title: Esophagectomy in the State of Florida: Is Regionalization of Care Warranted? Abstract P291]
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