Higher hospital surgical case volume was associated with a 53% reduction in postoperative mortality after esophagectomy compared with lower-volume hospitals (OR 0.47; 95% CI 0.42-0.53).
Meta-Analysis (n=385,469)
Does higher hospital volume reduce postoperative mortality in patients undergoing esophagectomy for esophageal cancer?
Higher-volume hospitals (≥45 esophagectomies/year) are associated with significantly lower postoperative mortality in patients with esophageal cancer, supporting centralization of this procedure.
Odds Ratio: 0.47 (95% CI 0.42–0.53)
BACKGROUND: Postoperative mortality plays an important role in evaluating the surgical safety of esophagectomy. Although postoperative mortality after esophagectomy is partly influenced by the yearly hospital surgical case volume (hospital volume), this association remains unclear. METHODS: Studies assessing the association between hospital volume and postoperative mortality in patients who underwent esophagectomy for esophageal cancer were searched for eligibility. Odds ratios were pooled for the highest versus lowest categories of hospital volume using a random effects model. The dose-response association between hospital volume and the risk of postoperative mortality was analyzed. The study protocol was registered with PROSPERO. RESULTS: Fifty-six studies including 385 469 participants were included. A higher-volume hospital significantly reduced the risk of postesophagectomy mortality by 53% compared with their lower-volume counterparts (odds ratio, 0.47; 95% CI: 0.42-0.53). Similar results were found in subgroup analyses. Volume-outcome analysis suggested that postesophagectomy mortality rates remained roughly stable after the hospital volume reached a plateau of 45 esophagectomies per year. CONCLUSIONS: Higher-volume hospitals had significantly lower postesophagectomy mortality rates in patients with esophageal cancer, with a threshold of 45 esophagectomies per year for a high-volume hospital. This remarkable negative correlation showed the benefit of a better safety in centralization of esophagectomy to a high-volume hospital.
Di et al. (Wed,) conducted a meta-analysis in Esophageal cancer (n=385,469). Highest category of hospital volume vs. Lowest category of hospital volume was evaluated on Postoperative mortality (OR 0.47, 95% CI 0.42-0.53). Higher hospital surgical case volume was associated with a 53% reduction in postoperative mortality after esophagectomy compared with lower-volume hospitals (OR 0.47; 95% CI 0.42-0.53).