Title

National outcomes after gastric resection for neoplasm

UMMS Affiliation

Department of Surgery; Senior Scholars Program

Publication Date

4-2007

Document Type

Article

Subjects

Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Confidence Intervals; Female; Gastrectomy; Hospital Mortality; Hospitalization; Humans; Male; Middle Aged; *Outcome Assessment (Health Care); Retrospective Studies; Sex Distribution; Stomach Neoplasms; United States

Disciplines

Clinical Epidemiology | Epidemiology | Health Services Research | Neoplasms | Oncology | Surgery

Abstract

HYPOTHESIS: That factors affecting outcomes of surgical resection in the treatment of gastric cancer can be identified using a large US database.

DESIGN: Retrospective observational study.

SETTING: The Nationwide Inpatient Sample from January 1, 1998, through December 31, 2003.

PATIENTS: We included 13 354 patient discharges (approximately 66 096 nationally by weighted analysis) who underwent gastric resection for neoplasm.

MAIN OUTCOME MEASURE: In-hospital mortality. Univariate analyses were performed by means of chi(2) tests. A multivariate logistic regression was performed to determine which variables were independently predictive of in-hospital mortality.

RESULTS: During the study period, 50 738 patients (approximately 250 420 nationally) were discharged with the diagnosis of gastric neoplasm. Of those, 13 354 (26.3%) underwent gastric resection during their hospitalization. In-hospital mortality for patients undergoing surgery was 6.0%, without significant change from 1998 through 2003. Factors predictive of significantly increased in-hospital mortality included low annual hospital surgical volume (lowest [or= 11 gastrectomies per year], 6.8% vs 4.9%; adjusted odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2-1.8]), older patient age (50-69 vsyears, 4.0% vs 2.1%; adjusted OR, 1.5; 95% CI, 1.1-2.2) (>or =70 vsyears, 8.6% vs 2.1%; adjusted OR, 2.9; 95% CI, 2.0-4.3), male sex (male vs female, 6.7% vs 5.0%; adjusted OR, 1.3; 95% CI, 1.1-1.5), and procedure type (total gastrectomy vs all other resections, 8.0% vs 5.3%; adjusted OR, 1.4; 95% CI, 1.2-1.7).

CONCLUSIONS: Higher annual surgical volume is predictive of lower in-hospital mortality for patients undergoing gastric resection for neoplasm. Other factors significantly associated with superior outcomes after gastric resection included diagnosis type, procedure type, younger age, female sex, and fewer comorbid conditions.

Rights and Permissions

Citation: Arch Surg. 2007 Apr;142(4):387-93. doi:10.1001/archsurg.142.4.387. Link to article on publisher's website

DOI of Published Version

10.1001/archsurg.142.4.387

Comments

Jillian Smith participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Archives of surgery (Chicago, Ill. : 1960)

PubMed ID

17441293