Study Explores Esophagectomy Case Volume and Mortality

Patient factors more strongly influence mortality rates than physician or hospital case volume

TUESDAY, Oct. 16 (HealthDay News) -- Patient factors such as age, race and comorbid conditions more strongly influence mortality rates following esophagectomy than the esophagectomy case volume of a particular surgeon or hospital, according to research published in the Archives of Surgery in September.

Michael Rodgers, M.D., of Oregon Health & Science University in Portland, and colleagues conducted a retrospective review of 8,075 esophagectomy cases from a national database in order to explore the relationship between case volume and outcomes.

The average mortality rate was 11.4 percent. Presence of comorbid conditions, age over 65, female sex, black race, and lower surgeon volume were independent risk factors for mortality. Overall, there was a modest relationship between surgeon and hospital volume and the probability of a low mortality rate, though there was wide variability between individual surgeons and hospitals. Low-volume hospitals (defined as those performing fewer than 13 cases per year) had a 61 percent probability of having mortality rates less than 10 percent, compared to 68 percent for high-volume hospitals.

"Inpatient mortality for esophagectomy is more strongly associated with patient variables than institution variables. The association between hospital and surgeon case volume and average inpatient mortality has been confirmed, although surgeon case volume is the more important factor and eliminates hospital volume in multivariate analysis," concluded the authors.

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