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Hospital volume, pr...
Hospital volume, proportion resected and mortality from oesophageal and gastric cancer : a population-based study in England, 2004-2008
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Coupland, Victoria H (författare)
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- Lagergren, Jesper (författare)
- Karolinska Institutet
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Lüchtenborg, Margreet (författare)
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Jack, Ruth H (författare)
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Allum, William (författare)
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- Holmberg, Lars (författare)
- Uppsala universitet,Endokrinkirurgi
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Hanna, George B (författare)
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Pearce, Neil (författare)
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Møller, Henrik (författare)
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(creator_code:org_t)
- 2012-10-19
- 2013
- Engelska.
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Ingår i: Gut. - : BMJ. - 0017-5749 .- 1468-3288. ; 62:7, s. 961-966
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
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- OBJECTIVE:This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England.DESIGN: 62 811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery: <30, 30-365, and >365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients.RESULTS:Increasing hospital volume was associated with lower mortality (p(trend)=0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with <20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (p(trend)<0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (p(trend)=0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (p(trend)<0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile).CONCLUSIONS:With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.
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