Surgical specialty, surgical unit volume and mortality after oesophageal cancer surgery

Background: Mortality after oesophagectomy is lower in high-volume than in low-volume surgical units. Case series from cardiothoracic surgeons report lower mortality rates than those from general surgeons. We therefore used a national data set to investigate the effects of surgical specialty and volume on mortality after oesophagectomy. Methods: We analysed Hospital Episode Statistics for oesophagectomy for cancer (n = 9034 cases), linked to data from death certificates, in England front 1998 to 2003. Results: After adjustment for patients' age, sex and deprivation score, the odds ratio (OR) for death of general surgeons' (GS) patients, compared with cardiothoracic surgeons' (CTS) patients. was significantly high: 1.62 [95% CI 1.34-1.96] at 30 days and 1.38 [1.18-1.61] at 90 days. The odds ratio for high-volume GS patients was not significantly different from that for high-volume CTS patients. However, the odds ratio for low-volume GS patients compared with high-volume CTS patients was significantly high: 1.72 (1.40-2.11) at 30 days and 1.48 (1.26-1.74) at 90 days. Conclusion: Patients treated by general Surgeons in low-volume hospitals had worse mortality outcomes than those treated by general surgeons in high-volume hospitals or by cardiothoracic-surgeons. This is important because a majority of patients who underwent oesophagectomy for cancer were in this high-mortality risk croup. (C) 2008 Elsevier Ltd. All rights reserved.