RT Journal
A1 Dimick JB, Cowan JA, Jr, Ailawadi G, Wainess RM, Upchurch GR, Jr
T1 NAtional variation in operative mortality rates for esophageal resection and the need for quality improvement
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD December 1
VO 138
IS 12
SP 1305
OP 1309
DO 10.1001/archsurg.138.12.1305
UL http://dx.doi.org/10.1001/archsurg.138.12.1305
AB Hypothesis 
    Operative mortality rates for esophageal resection vary across hospital volume groups in a nationally representative sample of hospitals.Design 
    Cross-sectional study of all adult patients in the Nationwide Inpatient Sample who underwent esophageal resection from 1995 through 1999 (N = 3023). Operative mortality was determined for hospital volume quartiles (low, <3 per year; medium, 3-5 per year; high, 6-16 per year; very high, >16 per year). Multiple logistic regression of in-hospital mortality was used for case-mix adjusted analyses.Setting 
    Hospitals performing at least 1 esophageal resection from 1995 through 1999 in the Nationwide Inpatient Sample.Patients 
    Patients having esophageal resection from 1995 through 1999 in the Nationwide Inpatient Sample.Results 
    Overall mortality was 8.2% and varied 3-fold from 11.8% to 3.7% across hospital volume groups (P<.001). In the case-mix–adjusted multivariate analysis, having surgery at a low-volume hospital (odds ratio, 2.9; 95% confidence interval, 1.7-4.9; P<.001) or medium-volume hospital (odds ratio, 2.4; 95% confidence interval, 1.4-4.3; P = .002) was associated with an increased risk of mortality compared with the reference group of very high–volume hospitals. The effect of volume on mortality was significant for both malignant and benign disease. Given the absolute risk difference of 8.1% between very high– and low-volume hospitals, only 12 patients would need to be referred to prevent 1 death after esophageal resection.Conclusions 
    The operative mortality rate for esophageal resection varies across hospitals in the United States. To improve the quality of care and reduce operative mortality rates for patients in need of esophageal surgery, patients should either be referred to higher-volume hospitals, or quality improvement should be directed at lower-volume hospitals.