University hospital status and surgeon volume and risk of reoperation following surgery for esophageal cancer

Abstract

Purpose: Centralization of surgery improves the survival following esophagectomy for cancer, but whether university hospital setting or surgeon volume influences the reoperation rates is unknown. We aimed to clarify whether hospital status or surgeon volume are associated with a risk of reoperation after esophagectomy.

Methods: Patients who underwent esophagectomy for esophageal cancer in 1987-2010 were identified from a population-based, nationwide Swedish cohort study. University hospital status and cumulative surgeon volume were analyzed in relation to risk of reoperation or death (the latter included to avoid competing risk errors) within 30 days of surgery. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), adjusted for calendar period, age, sex, comorbidity, tumor histology, stage, neoadjuvant therapy, resection margin, surgeon volume, and hospital status.

Results: Among 1820 participants, 989 (54%) underwent esophagectomy in university hospitals and 271 (15%) died or were reoperated within 30 days of surgery. Non-university hospital status was associated with an increased risk of reoperation or death compared to university hospitals (adjusted OR 1.56, 95% CI 1.13-2.13). Regarding surgeon volume, the ORs were increased in the lower volume categories, but not statistically significant (OR 1.30, 95% CI 0.89-1.89 for surgeon volume <7 and OR 1.10, 95% CI 0.75-1.63 for surgeon volume 7-16, compared to surgeon volume >16).

Conclusion: The risk of reoperation or death within 30 days of esophagectomy seems to be lower in university hospitals even after adjustment for surgeon volume and other potential confounders. These results support centralizing esophageal cancer patients to university hospitals.

Keywords: Esophagectomy; Esophagus; Neoplasm; Surgery.