Article ; Online: The effect of centralisation on the outcomes of oesophagogastric surgery--a fifteen year audit.
International journal of surgery (London, England)
2012 Volume 10, Issue 7, Page(s) 360–363
Abstract: Introduction: Centralisation of oesophagogastric (OG) resectional services has been proposed to improve patient outcomes in terms of perioperative mortality and long-term survival. Centralisation of services occurred in Gloucester 5 years ago. The aim ... ...
Abstract | Introduction: Centralisation of oesophagogastric (OG) resectional services has been proposed to improve patient outcomes in terms of perioperative mortality and long-term survival. Centralisation of services occurred in Gloucester 5 years ago. The aim of this paper is to assess if local patient outcomes have benefited from centralisation. Methods: All oesophagogastric resections performed in our unit over a 15-year period (10-years pre-centralisation and 5-years post-centralisation) were assessed retrospectively. Patient demographics, pathological details and date of death were identified. Perioperative mortality (30 and 90 day) and estimated Kaplan-Meier survival was compared for cases performed pre- and post-centralisation of services. Results: 456 resections for cancer were performed in the 15-year period; 234 of these were performed pre-centralisation (mean 23.4, range 13-31) and 222 were performed post-centralisation (mean 44.4, range 40-50). Median survival rates for gastric cancer were 1.1 years pre-centralisation and 1.5 years post-centralisation (p = 0.147) and median survival for oesophageal cancer improved from 1.1 years to 2.1 respectively (p = 0.028). Combined OG 30-day mortality rates improved from 10.3% pre-centralisation to 3.6% post-centralisation (p = 0.006, Fisher's exact test). Discussion: Centralisation of OG services in Gloucester has resulted in twice as many resections being performed locally. Median survival for patients with oesophageal cancer has increased by 1 year and the 30-day mortality rate following resection has reduced by almost two thirds. Although other factors (such as improvements in oncological treatments, staging and critical care management over the 15-year time period) have undoubtedly had roles to play in these improvements, the results of this study support the policy of centralisation of upper GI cancer services. |
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MeSH term(s) | Centralized Hospital Services/organization & administration ; Digestive System Surgical Procedures/methods ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Medical Audit ; Neoplasm Staging ; Retrospective Studies ; Specialties, Surgical/organization & administration ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Survival Rate ; Treatment Outcome |
Language | English |
Publishing date | 2012 |
Publishing country | England |
Document type | Journal Article |
ZDB-ID | 2212038-5 |
ISSN | 1743-9159 ; 1743-9191 |
ISSN (online) | 1743-9159 |
ISSN | 1743-9191 |
DOI | 10.1016/j.ijsu.2012.05.012 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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