Year 2017 / Volume 109 / Number 9
Original
Towards the centralization of digestive oncologic surgery: changes in activity, techniques and outcome

634-642

DOI: 10.17235/reed.2017.4710/2016

Cristian Tebé, Roger Pla, Josep Alfons Espinàs, Julieta Corral, Elisa Puigdomenech, Josep Maria Borràs, Joan M. V. Pons, Mireia Espallargues,

Abstract
Aim: The objective of the present study was to examine changes in the activity, surgical techniques and results from the process of centralization of complex digestive oncologic surgery in 2005-2012 as compared to 1996-2000. Material and methods: A retrospective cohort study employing the minimum basic data set of hospital discharge (MBDSHD 1996-2012) from public centers in Catalonia (Spain) was performed. The population consisted of individuals aged > 18 who underwent digestive oncologic surgery (esophagus, pancreas, liver, stomach or rectum). Medical centers were divided into low, medium, and high-volume centers (≤ 5, 6-10, and > 10 interventions/year, respectively). The tendency Chi-squared test was used to assess the centralization of patients in high-volume centers and hospital mortality evolution during the study period. Logistic regression was performed to assess the relationship between volume and outcome. Results: A centralization of complex oncologic digestive surgery between 10% (liver) and 46% (esophagus) was obtained by means of a reduction in the number of hospitals that perform these interventions and a significant rise in the number of patients operated in high-volume centers (all types p ≤ 0.0001, except for esophagus). A significant decrease in mortality was observed, especially in esophagus (from 15% in 1996/2000 to 7% in 2009/12, p = 0.003) and pancreas (from 12% in 1996/2000 to 6% in 2009/12, p trend < 0.0001). Conclusions: A centralization of oncologic digestive surgery in high-volume centers and a reduction of hospital mortality in Catalonia were reported among esophageal and pancreatic cancers. However, no significant changes were found for others cancer types.
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Tebé C, Pla R, Espinàs J, Corral J, Puigdomenech E, Borràs J, et all. Towards the centralization of digestive oncologic surgery: changes in activity, techniques and outcome. 4710/2016


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Publication history

Received: 04/11/2016

Accepted: 17/03/2017

Online First: 27/07/2017

Published: 31/08/2017

Article revision time: 99 days

Article Online First time: 265 days

Article editing time: 300 days


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