High hospital volume (>25 procedures/year) did not significantly differ in anastomotic leakage rates compared to lower volumes (17.6% vs 16.8%, OR 1.06, P=0.07), but had lower failure-to-rescue mortality.
Cohort (n=32,335)
Yes
Does hospital case volume impact anastomotic leakage rates and failure-to-rescue mortality in patients undergoing esophagectomy?
High-volume hospitals have significantly lower failure-to-rescue mortality rates following anastomotic leakage after esophagectomy, supporting the centralization of these procedures.
Odds Ratio: 1.06
Absolute Event Rate: 17.6% vs 16.8%
p-value: p=0.07
BACKGROUND: Anastomotic leakage (AL) is a major concern following esophagectomy due to the associated morbidity and mortality. The impact of hospital volume on postoperative outcomes after esophagectomy has previously been reported. The aim of this study was to analyze the current trends in postoperative anastomotic leakage and associated failure-to-rescue after esophagectomy in relation to hospital volume in German acute care hospitals using real-world data from the German Diagnosis-Related Groups (G-DRG) database. MATERIALS AND METHODS: A retrospective secondary data analysis of the G-DRG database was performed for all in-hospital cases of patients undergoing esophagectomy from 2013 to 2021. AL and in-house mortality rates were assessed in relation to hospital case volume and endoscopic treatment modalities. RESULTS: The study included 32 335 cases. The mean reported AL rate was 17.1% with a mean failure-to-rescue rate of 18.9%. AL rates did not differ between hospitals with an annual case-volume ≤ 25 procedures/year vs. >25 procedures/year (16.8% vs. 17.6%, OR 1.06, P = 0.07). However, in high-volume centers (> 25 procedures/year), in-hospital mortality for cases with AL (failure-to-rescue) was lower compared to medium-volume (10-25 cases/year) and low-volume (1-9 cases/year) centers (14.2% vs. 21.5% vs. 25.1%). The use of endoscopic vacuum therapy (EVT) increased over time, reaching 58.1% of AL cases in 2021 compared to 14.2% in 2013, while the use of self-expanding metal stents (SEMS) decreased from 37.0% in 2013 to 9.3% in 2021. CONCLUSIONS: AL rates after esophagectomy remain high. In-house mortality is significantly lower in high-volume hospitals highlighting the importance to consider improvements in centralization of procedures. Further efforts are needed to reduce AL rates and improve outcomes after esophagectomy.
Weber et al. (Wed,) conducted a cohort in Esophagectomy (n=32,335). High hospital volume (>25 procedures/year) vs. Hospital volume ≤25 procedures/year was evaluated on Anastomotic leakage rate (OR 1.06, p=0.07). High hospital volume (>25 procedures/year) did not significantly differ in anastomotic leakage rates compared to lower volumes (17.6% vs 16.8%, OR 1.06, P=0.07), but had lower failure-to-rescue mortality.