Hospital volume and hospital mortality far esophagectomy

BACKGROUND, Hospital mortality after esophagectomy has decreased from 29% t o 7.5% over the last decades because of improved surgical techniques and be tter perioperative care. Suggestions have been made that a further decrease in hospital mortality may be achieved by centralization of esophagectomies in high volume centers. METHODS, The effect of hospital volume on hospital mortality after esophage ctomy in the Netherlands tvas analyzed based on data from the Dutch Nationa l Medical Registry and the Dutch Network and National Database for Patholog y over the period 1993-1998. RESULTS. Annually, approximately 310 (range, 264-321) esophagectomies are p erformed in the Netherlands. Fifty-two percent are performed in 43-55 low v olume centers (1-10 resections a year). Six percent are performed in 1-3 me dium volume centers (11-20 resections a year). The remainder (42%) is perfo rmed in two high volume centers (> 50 resections a year). Hospital mortalit y is 12.1%, 7.5% and 4.9% respectively (P < 0.001). The high volume centers seem to see slightly more advanced tumors than the low and medium volume c enters. CONCLUSIONS. There is a significant (inverse) relation between hospital mor tality and hospital volume for esophageal resection in the Netherlands. Alt hough hospital mortality is nor the only measure for quality of care, these data suggest a potential beneficial effect to centralization of esophagect omy in the Netherlands. Cancer 2001;91:1574-8. (C) 2001 American Cancer Soc iety.