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NESS 2006 Annual Meeting
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National Outcomes After Gastric Resection for Neoplasm
Jillian K Smith, James T McPhee, Giles F Whalen, Mary E Sullivan, Jason T Wong, Robert E Quinlan, Demetrius E Litwin, Frederick A Anderson, Jennifer F Tseng
University of Massachusetts Medical School, Worcester, MA

Objective: To evaluate factors affecting outcomes of surgical resection in the treatment of gastric cancer using a large national database.
Design: Retrospective observational study.
Setting: The Nationwide Inpatient Sample 1998-2003.
Patients: 13,485 patient discharges (estimated 66,748 patient discharges nationally by weighted analysis) who underwent gastric resection for neoplasm.
Interventions: None.
Main Outcome Measure: In-hospital mortality. Univariate analyses were performed by chi-square. A multivariate logistic regression was performed to determine which variables were independently predictive of in-hospital mortality.
Results: 50,738 patients (estimated 250,420 patients nationally) were discharged with the diagnosis of gastric neoplasm during the time period of this study. Of those, 13,485 (26.6%) underwent gastric resection during their hospitalization. In-hospital operative mortality was 6.0%, without significant change from 1998-2003. Factors significantly predictive of increased operative mortality included low annual hospital surgical volume (lowest volume (<=3/year) versus highest (>16/year), 6.7% vs. 4.4%, O.R. 1.40 (95% C.I. 1.04-1.94)); older patient age (50-69 vs. <50, 4.0% vs. 2.2%, O.R. 1.54 (95% C.I. 1.06-2.26); at least 70 vs. <50, 8.6% vs. 2.2%, O.R. 2.94 (95% C.I. 1.97-4.38)); male sex (male vs. female, 6.7% vs. 5.0%, O.R. 1.29 (95% C.I. 1.09-1.52)); and procedure type (total gastrectomy vs. all other resections, 8.0% vs. 5.3%, O.R. 1.42 (95% C.I. 1.20-1.69)).
Conclusions: Higher annual surgical volume is predictive of lower operative mortality for patients undergoing gastric resection for neoplasm. In addition to volume, other factors significantly associated with superior outcomes after gastric resection included younger age, fewer comorbid conditions, and female sex.

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