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Annals of Surgical Oncology

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Trends in Volume–Outcome Relationship in Gastrectomies in Texas

Naruhiko Ikoma MD, MS, Bumyang Kim PhD, Linda S. Elting DrPH, Ya-Chen Tina Shih PhD, Brian D. Badgwell MD, MS, Paul Mansfield MD
Health Services Research and Global Oncology
Volume 26, Issue 9 / September , 2019



We previously reported a significant volume–outcome relationship in mortality rates after gastrectomies for gastric cancer patients in Texas (1999–2001). We aimed to identify whether changes in the volume distribution of gastrectomies occurred, whether volume–outcome relationships persisted, and potential changes in the factors influencing volume–outcome relationships.


We performed a population-based study using the Texas Inpatient Public Use Data File between 2010 and 2015. Hospitals were classified as high-volume centers (HVCs, > 15 cases per year), intermediate-volume centers (IVCs, 3–15 cases per year), and low-volume centers (LVCs, < 3 cases per year). We conducted multivariate analyses to evaluate factors associated with inpatient mortality and adverse events.


We identified 2733 gastric cancer patients who underwent gastrectomy at 193 hospitals. Fewer hospitals performed gastrectomy than previously (193 vs. 214). There were more HVCs (5 vs. 2) and LVCs (142 vs. 134), but fewer IVCs (46 vs. 78). The proportion of patients who underwent gastrectomy at HVCs and LVCs increased, while the proportion at IVCs decreased. HVCs maintained lower in-hospital mortality rates than IVCs or LVCs, although mortality rates decreased in both LVCs and IVCs. In adjusted multivariate analyses, treatment at HVCs remained a strong predictor for lower rates of mortality (odds ratio [OR] 0.39, p = 0.019) and adverse events (OR 0.56, p = 0.013).


Despite improvements, patient morbidity and mortality at LVCs and IVCs remain higher than at HVCs, demonstrating that volume–outcome relationships still exist for gastrectomy and that opportunities for improvement remain.

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