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Relationship between hospital surgical volume and the perioperative esophagectomy costs for esophageal cancer: a nationwide administrative claims database study

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Abstract

Background

Numerous studies have described positive relationships between hospital volume (HV) and clinical outcomes in highly complex procedures, including esophagectomies. Although the centralization of surgery has been considered a possible solution for improving clinical outcomes, the HV impact on perioperative healthcare costs is unknown. This study aimed to determine the relationship between HV and perioperative healthcare costs for patients undergoing esophagectomy for esophageal cancer.

Methods

This retrospective, nationwide cohort study used Japanese Administrative Claims Database data. Data on esophagectomies performed nationwide in 2015 were extracted. The outcome measure was perioperative healthcare costs per person from the perspective of the insurer. The healthcare costs in outpatient or inpatient settings of any hospital and clinic where patients received treatment were summed up from the month the surgery was performed to 3 months after. Linear regression analyses were conducted to assess the risk-adjusted effects of the HV category (1–4/5–9/10–14/15–) on perioperative costs.

Results

A total of 5232 patients underwent an esophagectomy at 584 hospitals. The overall perioperative cost was 20.834 billion Japanese yen (JPY). The median perioperative costs per person for each HV category (1–4/5–9/10–14/15–) were 3.728 (709 patients), 3.740 (658 patients), 3.760 (512 patients), and 3.760 (3253 patients) million JPY, respectively (P = 0.676). Multivariate analyses revealed that each HV category had no significant impact on perioperative costs.

Conclusions

There were no significant differences in the perioperative costs between high- and low-volume centers. Esophageal cancer surgery centralization may be achievable without increasing healthcare costs.

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Data availability

The dataset analyzed in this study was used following the handling protocols of the Japanese Ministry of Health, Labour, and Welfare. It has been decided that the data must be deleted as soon as possible after the end of the study, and it is impossible to supply the datasets after the end.

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Acknowledgements

We would like to thank all those who are involved in the maintenance of the NDB. We would like to thank Editage (www.editage.com) for English language editing.

Funding

No financial support was received for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Takashi Sakamoto, Tatsuto Nishigori, Shigeru Tsunoda, Shigeo Hisamori, Koya Hida & Kazutaka Obama

  2. Graduate School of Business Administration, Keio University, Tokyo, Japan

    Rei Goto

  3. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Koji Kawakami

  4. Department of Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Takeo Nakayama

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  1. Takashi Sakamoto
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Contributions

TN, KK, RG, and TN contributed to the conception and design of this study. The plan was also scrutinized by TS, SH, KH, and KO from the perspectives of gastrointestinal surgeons. TS and TN analyzed and interpreted the data and drafted the article. All the authors contributed to the critical revision of this article.

Corresponding author

Correspondence to Tatsuto Nishigori.

Ethics declarations

Ethical statement

The study protocol was approved by the ethics committee of Kyoto University and the Ministry of Health, Labor, and Welfare (MHLW) advisory committee, which is composed of representatives of insurers and providers, academics, and journalists.

Conflict of interest

KK received research funds from AstraZeneca, Eisai Co., Ltd., Kyowa Kirin Co., Ltd., OMRON Corporation, and Toppan Inc.; consulting fees from Advanced Medical Care Inc., JMDC Inc., Shin Nippon Biomedical Laboratories Ltd., and Ubicom Holdings Inc.; executive compensation from Cancer Intelligence Care Systems, Inc.; and honoraria from Kyoto University Original Co., Ltd., Pharma Business Academy, and Shionogi & Co., Ltd. The other authors declare that they have no conflicts of interest.

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Sakamoto, T., Nishigori, T., Goto, R. et al. Relationship between hospital surgical volume and the perioperative esophagectomy costs for esophageal cancer: a nationwide administrative claims database study. Esophagus (2024). https://doi.org/10.1007/s10388-024-01092-6

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  • DOI: https://doi.org/10.1007/s10388-024-01092-6

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