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Jillian K. Smith, MPH; James T. McPhee, MD; Joshua S. Hill, MD; Giles F. Whalen, MD; Mary E. Sullivan, MS; Demetrius E. Litwin, MD, MBA; Frederick A. Anderson, PhD; Jennifer F. Tseng, MD

Arch Surg. 2007;142(4):387-393.

Hypothesis  That factors affecting outcomes of surgical resection in the treatment of gastric cancer can be identified using a large US database.

Design  Retrospective observational study.

Setting  The Nationwide Inpatient Sample from January 1, 1998, through December 31, 2003.

Patients  We included 13 354 patient discharges (approximately 66 096 nationally by weighted analysis) who underwent gastric resection for neoplasm.

Main Outcome Measure  In-hospital mortality. Univariate analyses were performed by means of ² tests. A multivariate logistic regression was performed to determine which variables were independently predictive of in-hospital mortality.

Results  During the study period, 50 738 patients (approximately 250 420 nationally) were discharged with the diagnosis of gastric neoplasm. Of those, 13 354 (26.3%) underwent gastric resection during their hospitalization. In-hospital mortality for patients undergoing surgery was 6.0%, without significant change from 1998 through 2003. Factors predictive of significantly increased in-hospital mortality included low annual hospital surgical volume (lowest [4 gastrectomies per year] vs highest [11 gastrectomies per year], 6.8% vs 4.9%; adjusted odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2-1.8]), older patient age (50-69 vs <50 years, 4.0% vs 2.1%; adjusted OR, 1.5; 95% CI, 1.1-2.2) (70 vs <50 years, 8.6% vs 2.1%; adjusted OR, 2.9; 95% CI, 2.0-4.3), male sex (male vs female, 6.7% vs 5.0%; adjusted OR, 1.3; 95% CI, 1.1-1.5), and procedure type (total gastrectomy vs all other resections, 8.0% vs 5.3%; adjusted OR, 1.4; 95% CI, 1.2-1.7).

Conclusions  Higher annual surgical volume is predictive of lower in-hospital mortality for patients undergoing gastric resection for neoplasm. Other factors significantly associated with superior outcomes after gastric resection included diagnosis type, procedure type, younger age, female sex, and fewer comorbid conditions.

Author Affiliations: Department of Surgery, University of Massachusetts Medical School, Worcester.

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