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The association between hospital high-volume anesthesiology care and patient outcomes for complex gastrointestinal cancer surgery: a population-based study


Objective — To examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity.

Summary Background Data — Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown.

Methods — We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3-5). Scatter plots visualized the relationship between each hospital’s adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression.

Results — For 7,893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0 to 87.6%, and of major morbidity from 38.2 to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson −0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio 0.96; 95% confidence interval 0.95-0.98; P-value<0.001 for each 10% increase in the high-volume rate).

Conclusions — Hospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital’s rate of major morbidity.



Hallet J, Jerath A, Perez d’Empaire P, Eskander A, Carrier F, McIsaac DI, Turgeon A, Idestrup C, Flexman AM, Lorello G, Darling G, Kidane B, Kaliwal Y, Barabash V, Coburn N, Sutradhar R. Ann Surg. 2023; 278(3):e503-10. Epub 2022 Oct 27.

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