Dynamic volume-outcome association for esophagectomies: Do current volume thresholds still apply?

Area of Science:

• Surgical Oncology
• Health Services Research

Background:

• Current hospital case volume recommendations for esophagectomy may not reflect contemporary practice.
• The established minimum of 20 annual cases per hospital is met by only 1.1% of institutions.

Purpose of the Study:

• To evaluate the applicability of the current minimum case volume recommendation for esophagectomy.
• To assess trends in 30-day mortality and determine if the recommended volume threshold is still relevant.

Main Methods:

• Analysis of esophageal resection data from 2005-2015 in the National Cancer Database.
• Hospitals categorized into low, medium, and high-volume strata based on quartiles.
• Logistic regression used to calculate adjusted 30-day mortality and analyze trends.

Main Results:

• Overall unadjusted 30-day mortality for esophagectomy was 3.8%.
• Adjusted 30-day mortality decreased across all volume strata between 2005 and 2015.
• By 2015, 7 annual cases achieved similar adjusted 30-day mortality as 20 cases in the overall cohort.

Conclusions:

• Only a small fraction of hospitals meet the current 20-case minimum for esophagectomy.
• Improvements in care have lowered mortality, making lower volume thresholds achievable.
• Revising volume recommendations could enhance access to quality esophagectomy care.