Abstract
Background
Surgical treatment for gastric cancer has evolved substantially. To understand how
changes in patient- and hospital-level factors are associated with outcomes over the
last decade, we examined a nationally representative sample.
Methods
Retrospective cross-sectional discharge data from the 2001–2010 Nationwide Inpatient
Sample were analyzed using cross tabulation and multivariable regression modeling.
Patients with a primary diagnosis of gastric cancer undergoing gastrectomy as primary
procedure were included. We examined relationships between patient- and hospital-level
factors, surgery type, and outcomes including in-hospital mortality and length of
stay (LOS).
Results
A total of 67,327 patients with gastric cancer undergoing gastrectomy nationwide with
complete information were included. Compared with patients treated in 2001, patients
in 2010 were younger, more likely admitted electively, treated in a teaching hospital,
or at an urban center. There was no difference in the type of procedure performed
over time. Factors associated with an increased risk of in-hospital mortality included
older age, male gender, and nonelective admission (P < 0.05). In multivariable analysis, patients undergoing gastrectomy in 2010 demonstrated
40% lower odds of in-hospital mortality (odds ratio, 0.60; P = 0.008). Overall mean LOS was 13.9 d (standard error, 0.1) without change over time.
Factors associated with longer LOS included procedure type, hospital location, nonelective
admission, and comorbid disease (all P < 0.05).
Conclusions
The adjusted odds of in-hospital mortality among surgically treated patients with
gastric cancer decreased >40% between 2001 and 2010. Further research is warranted
to determine if these findings are due to better patient selection, regionalization
of care, or improvement of in-hospital quality of care.
Keywords
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Article info
Publication history
Published online: March 14, 2014
Accepted:
March 5,
2014
Received in revised form:
February 26,
2014
Received:
January 4,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
