Hospital volume of esophageal cancer surgery in relation to outcomes from primary anti-reflux surgery

2020 ◽  
Author(s):  
Sheraz Markar ◽  
Giola Santoni ◽  
John Maret-Ouda ◽  
Jesper Lagergren
Keyword(s):  
Esophageal Cancer ◽  
Hospital Volume ◽  
Cox Regression ◽  
Population Based ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery ◽  
Hazard Ratios ◽  
Volume Group ◽  
Annual Volume

Summary No previous study has sought to identify the effect of hospital volume of esophagectomy on anti-reflux surgery outcomes. The hypothesis under investigation was hospitals performing esophagectomies, particularly those of higher annual volume, have better outcomes from primary anti-reflux surgery. This population-based cohort study included adult individuals (≥18 years) in Sweden receiving primary anti-reflux surgery for a recorded gastro-esophageal reflux disease in 1997–2010, with follow-up until 2013 The ‘exposure’ was hospital volume of esophagectomy, with hospitals conducting esophagectomies divided into 0, >0–1, >1–3 and ≥ 4 based on annual volume, and hospitals not conducting esophagectomies were the reference category. The outcomes were 30-day re-intervention and surgical re-intervention during the entire follow-up after anti-reflux surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, type of anti-reflux surgery, and year of anti-reflux surgery. Among 10,959 participants having undergone primary anti-reflux surgery, the 30-day re-intervention rate was 1.1%, and the rate of surgical re-intervention during the entire follow-up was 6.8%. Compared with hospitals not performing esophagectomy, hospitals in the highest volume group of esophagectomy showed no decreased risks of 30-day re-intervention (HR = 1.46, 95% CI 0.89–2.39) or surgical re-intervention (HR = 1.21, 95%CI 0.91–1.60) during follow-up. Similarly, the intermediate hospital volume categories of esophageal cancer surgery had no decreased risk of surgical re-interventions after anti-reflux surgery. This study provides no evidence for centralization of primary anti-reflux surgery to centers for esophageal cancer surgery.

Hospital and Surgeon Volume in Relation to Survival After Esophageal Cancer Surgery in a Population-Based Study

2013 ◽  
Vol 31 (5) ◽  
pp. 551-557 ◽  
Author(s):  
Maryam Derogar ◽  
Omid Sadr-Azodi ◽  
Asif Johar ◽  
Pernilla Lagergren ◽  
Jesper Lagergren
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factors ◽  
Hospital Volume ◽  
Tumor Stage ◽  
Population Based ◽  
Early Postoperative Period ◽  
Surgeon Volume ◽  
Cancer Surgery ◽  
Swedish Population ◽  
Esophageal Cancer Surgery

Purpose The influence of hospital and surgeon volume on survival after esophageal cancer surgery deserves clarification, particularly the prognosis after the early postoperative period. The interaction between hospital and surgeon volume, and the influence of known prognostic factors need to be taken into account. Methods A nationwide Swedish population-based cohort study of 1,335 patients with esophageal cancer who underwent esophageal resection in 1987 to 2005, with follow-up for survival until February 2011, was conducted. The associations between annual hospital volume, annual surgeon volume, and cumulative surgeon volume and risk of mortality were calculated with multivariable parametric survival analysis, providing hazard ratios (HRs) with 95% CIs. HRs were mutually adjusted for the surgery volume variables and further adjusted for the prognostic factors age, sex, comorbidity, calendar period, tumor stage, tumor histology, and neoadjuvant therapy. Results There was no independent association between annual hospital volume and overall survival, and hospital volume was not associated with short-term mortality after adjustment for hospital clustering effects. A combination of higher annual and cumulative surgeon volume reduced the mortality occurring at least 3 months after surgery (P trend < .01); the HR was 0.78 (95% CI, 0.65 to 0.92) comparing surgeons with both annual and cumulative volume above the median with those below the median. These results remained when hospital and surgeon clustering were taken into account. Conclusion Because surgeon volume rather than hospital volume independently influences the prognosis after esophageal cancer surgery, centralization of this surgery to fewer surgeons seems warranted.

scholarly journals Plasma Vitamin B12 Levels, High-Dose Vitamin B12 Treatment, and Risk of Dementia

2021 ◽  
Vol 79 (4) ◽  
pp. 1601-1612
Author(s):  
Johan Frederik Håkonsen Arendt ◽  
Erzsébet Horváth-Puhó ◽  
Henrik Toft Sørensen ◽  
Ebba Nexø ◽  
Lars Pedersen ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Vascular Dementia ◽  
Cox Regression ◽  
Population Based ◽  
High Dose ◽  
Plasma Vitamin ◽  
Hazard Ratios ◽  
B12 Deficiency ◽  
First Time

Background: It is controversial whether B12 deficiency causes dementia or B12 treatment can prevent dementia. Objective: To assess associations between low plasma (P-)B12 levels, B12 treatment, and risk of Alzheimer’s disease (AD; primary outcome) and all-cause or vascular dementia (secondary outcomes). Methods: We conducted a population-based cohort study using Danish registry data to assess associations between low P-B12 levels, high-dose injection or oral B12 treatment, and risk of dementia (study period 2000–2013). The primary P-B12 cohort included patients with a first-time P-B12 measurement whose subsequent B12 treatment was recorded. The secondary B12 treatment cohort included patients with a first-time B12 prescription and P-B12 measurement within one year before this prescription. For both cohorts, patients with low P-B12 levels (<200 pmol/L) were propensity score-matched 1:1 with patients with normal levels (200–600 pmol/L). We used multivariable Cox regression to compute 0–15-year hazard ratios for dementia. Results: For low P-B12 and normal P-B12 level groups, we included 53,089 patients in the primary P-B12 cohort and 13,656 patients in the secondary B12 treatment cohort. In the P-B12 cohort, hazard ratios for AD centered around one, regardless of follow-up period or treatment during follow-up. In the B12 treatment cohort, risk of AD was unaffected by low pre-treatment P-B12 levels, follow-up period and type of B12 treatment. Findings were similar for all-cause and vascular dementia. Conclusion: We found no associatio1n between low P-B12 levels and dementia. Associations were unaffected by B12 treatment. Results do not support routine screening for B12 deficiency in patients with suspected dementia.

Headache as a risk factor for dementia: A prospective population-based study

Cephalalgia ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Knut Hagen ◽  
Eystein Stordal ◽  
Mattias Linde ◽  
Timothy J Steiner ◽  
John-Anker Zwart ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Cox Regression ◽  
Subsequent Development ◽  
Population Based ◽  
Health Study ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Increased Risk

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

scholarly journals Milk drinking and risk of hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

2019 ◽  
Vol 121 (6) ◽  
pp. 709-718 ◽  
Author(s):  
Kristin Holvik ◽  
Haakon E. Meyer ◽  
Ida Laake ◽  
Diane Feskanich ◽  
Tone K. Omsland ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Cox Regression ◽  
Population Based ◽  
Third Wave ◽  
Hospital Data ◽  
High Fracture ◽  
Hazard Ratios ◽  
Meta Analyses

AbstractMilk provides energy and nutrients considered protective for bone. Meta-analyses of cohort studies have found no clear association between milk drinking and risk of hip fracture, and results of recent studies are contradictory. We studied the association between milk drinking and hip fracture in Norway, which has a population characterised by high fracture incidence and a high Ca intake. Baseline data from two population-based cohorts were used: the third wave of the Norwegian Counties Study (1985–1988) and the Five Counties Study (2000–2002). Diet and lifestyle variables were self-reported through questionnaires. Height and weight were measured. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Of the 35 114 participants in the Norwegian Counties Study, 1865 suffered a hip fracture during 613 018 person-years of follow-up. In multivariable Cox regression, hazard ratios (HR) per daily glass of milk were 0·97 (95 % CI 0·92, 1·03) in men and 1·02 (95 % CI 0·96, 1·07) in women. Of 23 259 participants in the Five Counties Study, 1466 suffered a hip fracture during 252 996 person-years of follow-up. HR for hip fractures per daily glass of milk in multivariable Cox regression was 0·99 (95 % CI 0·92, 1·07) in men and 1·02 (95 % CI 0·97, 1·08) in women. In conclusion, there was no overall association between milk intake and risk of hip fracture in Norwegian men and women.

Screening and treatment strategy for double cancer for esophageal cancer surgery patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 336-336
Author(s):  
Takashi Ogata ◽  
Yota Shimoda ◽  
Kazuki Kano ◽  
Keisuke Koumori ◽  
Hayato Watanabe ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Strategy ◽  
Cancer Surgery ◽  
Double Cancer ◽  
Esophageal Cancer Surgery ◽  
Double Cancers

336 Background: Esophageal cancer treatment, especially esophagectomy, is highly invasive, so treatment strategies are considered in view of existing double cancers. On the other hand, in Japan, 90% of esophageal cancers are squamous cell carcinoma, and it is known that there are a large proportion of head and neck cancers for double cancers as field cancerization. Methods: The aim of this study is to investigate the types of double cancer, simultaneous/metachronous, and the frequency and treatment policy of head and neck cancer as a particularly high coexistence rate for esophageal cancer surgery patient. The subjects were 304 patients who underwent esophagectomy performed from April 2010 to December 2017. All patients were examined with high-definition endoscopy with NBI by certificated endoscopist at the first visit as a search for simultaneous double cancer from the pharynx to the stomach. And after esophagectomy, endoscopy was also performed to check for metachronous double cancers in the remaining esophagus, gastric tube, and pharynx at least every 2 years. Results: The number of double cancer cases was found in 94 cases (30.9%), and the total number of double cancer cases was 122. Head and neck cancer(33 cases), stomach cancer(16 cases), and colon cancer(12 cases) were observed as the main course of double cancers. In double cancer cases, 47cases(50.0%) were metachronous, 35cases(37.2%) were simultaneous, and 12cases(12.8%) were both synchronous. The most common double cancer was head and neck cancer(33 cases:35.1%), and 23 cases were simultaneous, 10 cases were metachronous. As treatment strategy for head and neck cancer, endoscopic laryngo-pharyngo surgery(ELPS) were 19 cases. 10 cases(52.7%) were synchronous cancers, and 9 cases (47.3%) were metachronous cancers which were detected during follow-up after esophagectomy. Conclusions: Head and neck cancer associated with esophageal cancer surgery is the most common type of double cancer, and 1/3 of ELPS cases have been detected by follow-up endoscopy after esophagectomy, so endoscopic surveillance was also considered important.

The role of diabetes and other co-morbidities on survival after esophageal cancer surgery in a population-based study

2013 ◽  
Vol 206 (4) ◽  
pp. 539-543 ◽  
Author(s):  
Lovisa Backemar ◽  
Therese Djärv ◽  
Anna Wikman ◽  
Asif Johar ◽  
Paul Ross ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Population Based ◽  
Cancer Surgery ◽  
Population Based Study ◽  
Esophageal Cancer Surgery

scholarly journals 1067Annual changes in job strain and risk of coronary heart disease in Denmark

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Jeppe Karl Sørensen ◽  
Elisabeth Framke ◽  
Ida E.H. Madsen ◽  
Reiner Rugulies
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cox Regression ◽  
Job Strain ◽  
Population Based ◽  
Job Exposure Matrix ◽  
Hazard Ratios ◽  
Annual Changes ◽  
Mean Time

Abstract Background We examined the association between annual changes in job strain and incident coronary heart disease (CHD) in a population-based cohort study in Denmark. Methods We studied all workers residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N = 1,660,150). Using a job exposure matrix (JEM) with annual updates, we assessed changes in job strain from 2000-2009. Incident CHD was identified in hospital and death registers from 2001 to 2010. Using Cox regression, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for the association between annual changes in job strain and incident CHD. Results During 16.1 million person-years (mean time of follow-up: 9.7 years), we identified 24,159 CHD cases (15.0 per 10,000 person-years). Compared to persistent no job strain, persistent job strain (HR 1.07, 95% CI 1.03–1.10), onset of job strain (HR 1.20, 95% CI 1.12–1.29) and removal of job strain (HR 1.20, 95% CI 1.12–1.28) were associated with higher CHD incidence. Conclusions Persistent and onset of job strain was associated with a higher risk of CHD. Removal of job strain was also associated with a higher risk, which might be due to health selection. Our results suggest that job strain contributes to risk of CHD in the Danish workforce. Key messages Implementing JEM in a population-based cohort of more than 1.6 million workers enabled us to demonstrate associations between annual changes in job strain and risk of incident CHD.

281 ANALYSIS OF NON-CANCER-RELATED DEATH CASES AFTER ESOPHAGEAL CANCER SURGERY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Norihisa Uemura ◽  
Takahiro Saiki ◽  
Toshiyuki Arai
Keyword(s):  
Esophageal Cancer ◽  
Radical Resection ◽  
The Elderly ◽  
Forced Expiratory Volume ◽  
Cancer Surgery ◽  
Nutrition Management ◽  
Esophageal Cancer Surgery ◽  
One Year ◽  
Death Cases

Abstract   Many patients with esophageal cancer have problems with preoperative physiological functions related to smoking, drinking, and malnutrition. Therefore, a certain frequency of patients die from other diseases after radical resection of esophageal cancer. In this study, we examined non-cancer-related death cases after esophageal cancer surgery to clarify the clinical significance and to consider its improvements. Methods In this retrospective cohort study, we examined 52 patients with esophageal cancer treated surgically from 2011 to 2016. Of the 52 patients analyzed, 7 died of other diseases during postoperative follow-up. Seven of the 52 patients were women, but all 7 died of other diseases were men. The median age of the 7 patients was 72 (65–76) years, slightly older than the median age of 66 (50–76) years in all cases. Results The postoperative survival of the 7 patients who died from other diseases was 9.4 months, including four patients who died early within one year without recurrent lesions. Their death was due to aspiration pneumonia in 5, 1 asphyxiation, and 1 unknown. The median preoperative BMI of the 7 patients who died of other diseases was 19.5, lower than 21.4 in all cases. The median preoperative one second forced expiratory volume was 2.36 L for the 7 patients, which was lower than 2.54 L in all cases. Conclusion Other deaths after esophagectomy were more common in men, the elderly, thinner, and patients with reduced respiratory function. Because there are some cases of death from other diseases early after esophagectomy, early rehabilitation intervention and nutrition management are required after surgery.

Sign in / Sign up

Export Citation Format

Share Document