In various countries, the association of lower hospital volume and
higher mortality after oesophageal, gastric, pancreatic and rectal
cancer resection has been clearly demonstrated. However, scientific
evidence regarding the volume-outcomes relationship for high-risk
visceral surgical procedures in Switzerland is lacking. The a priori
hypothesis of this retrospective population-based cohort study
analysis was that low-volume hospitals in Switzerland have a higher
rate of postoperative mortality after oesophageal, gastric,
pancreatic and rectal cancer resection.
Patients undergoing elective resection of oesophageal, gastric,
pancreatic and rectal cancer between 1999 and 2012 were identified
in the inpatient database of the Swiss Federal Statistical Office.
Nonparametric correlation analyses were used to assess time trends.
Mortality was assessed in univariable and risk-adjusted conditional
logistic regression analyses with stratification for year of
A total of 1487 oesophageal, 4404 gastric, 2668 pancreatic and 9743
rectal cancer patients were identified. For all cancer entities,
significant treatment centralisation was observed over the time
period (all p <0.001). The rate of mortality was inversely
related to the annual number of patients treated at a certain
hospital. The decrease of postoperative mortality from low-volume to
high-volume hospitals was 6.3% to 3.3% for oesophageal cancer (p =
0.019), 4.9% to 3.3% for gastric cancer (p = 0.023), 5.4% to 2.0%
for pancreatic cancer (p = 0.037), and 2.4% to 1.6% for rectal
cancer (p = 0.008). These results were confirmed in risk-adjusted
analyses with a decreased odds of pos-operative death by 49% for
oesophageal (odds ratio [OR] 0.51, 95% confidence interval [CI]
0.22-1.18; p = 0.085), 32% for gastric (OR 0.68, 95% CI 0.48-0.98; p
= 0.032), 68% for pancreatic (OR 0.32, 95% CI 0.11-0.89; p = 0.011)
and 29% for rectal cancer (OR 0.71, 95% CI 0.52-0.98; p =
This population-based analysis - the first of its kind in the
literature - demonstrates a higher postoperative mortality in
low-volume hospitals for patients undergoing oesophageal, gastric,
pancreatic and rectal cancer resection in Switzerland. Hence, such
operations should preferably be performed in high-volume hospitals.
Gueller U, Warschkow R, Ackermann C J, Schmied B, Cerny T, Ess S.
Lower hospital volume is associated with higher mortality after
oesophageal, gastric, pancreatic and rectal cancer resection. Swiss
Med Wkly 2017; 147:w14473.