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Trends in Major Gastrectomy for Cancer: Frequency and Outcomes. J Gastrointest Surg 2018 Dec 03 PMID: 30511132

Pubmed ID

30511132

Abstract

BACKGROUND: Declining incidence of gastric cancer in the USA has presumably resulted in lower rates of major gastrectomy for cancer. The impact on perioperative outcomes remains undefined. The aims of this study were to characterize national trends in frequency of major gastrectomy for cancer, identify factors associated with in-hospital mortality, and examine outcome disparities by race/ethnicity.

METHODS: Nationwide inpatient sample data from 1993 to 2013 were queried for procedural and diagnostic codes (ICD-9) relating to total and partial gastrectomy procedures. Gastric resections for cancer were compared to those for peptic ulcer disease for reference. Patient demographics, comorbidity score, mortality, and hospital characteristics were recorded as covariates.

RESULTS: A significant decrease in annual rates of partial and total gastrectomy was observed from 1993 to 2013 (pā€‰<ā€‰0.0001). The change in absolute number and percent decline was greater for partial gastrectomy (-ā€‰39.3%) than total gastrectomy (-ā€‰19%). There was a 34.0% decrease in gastrectomy for cancer in Whites and a 61.2% increase among Hispanic patients over two decades. In-hospital mortality also significantly decreased over the study period (7.7% to 2.7%). Factors associated with lower mortality rates included male sex and treatment at urban teaching hospitals. Analysis of trends revealed that gastrectomy for cancer was performed with increasing frequency at urban teaching hospitals.

CONCLUSIONS: The frequency of major gastric resections in the USA has declined over two decades. Overall, in-hospital mortality rates also have decreased significantly. Declining in-hospital mortality after gastrectomy for cancer is associated with more frequent treatment at urban teaching hospitals.

Author List

Groh EM, Hyun N, Check D, Heller T, Ripley RT, Hernandez JM, Graubard BI, Davis JL

Author

Noorie Hyun PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin




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