چکیده (انگلیسی):

Objective: Little information is available on the relationship between hospital volume
and the outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity.
This study aimed to investigate the influence of hospital volume on patient outcomes of
laparoscopic gastrectomy for gastric cancer in patients with comorbidity using a national
administrative database.
Methods: A total of 5941 comorbid patients treated with laparoscopic gastrectomy for gastric
cancer were referred to 741 hospitals in Japan. We collected patients’ data from the administrative
database to compare laparoscopy-related complications, in-hospital mortality, length
of stay (LOS), and medical costs during hospitalization in relation to hospital volume. Hospital
volume was categorized into two groups: low (<40 cases in 3 years; n Z 4111) and high (
40
cases; n Z 1830).
Results: There were no significant differences between the groups in laparoscopy-related complications
and in-hospital mortality (p Z 0.684 and p Z 0.200, respectively). However, significant
variations in mean LOS and medical costs were observed between hospital volume
categories (26.1 days vs. 20.2 days and 16,163.9 US dollars vs. 14,345.9 US dollars, respectively;
p < 0.001). Multiple linear regressions revealed that higher hospital volume was significantly
associated with shorter LOS and lower medical costs during hospitalization. The
unstandardized coefficient for LOS was 4.62 days (95% confidence interval Z 5.63e
3.60, p < 0.001), whereas that for medical costs was 1424.1 US dollars (95% confidence
interval Z 1962.5e885.6, p < 0.001).
Conf Conclusion: Hospital volume was significantly associated with a decrease of LOS and medical
costs of comorbid patients undergoing laparoscopic gastrectomy for gastric cancer.