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OC-073 Impact of centralisation of o-g cancer surgery on the number of trusts performing surgery, trust volume and 30 and 90 day postoperative mortality
  1. M Varagunam1,
  2. D Cromwell2,
  3. R Hardwick3,
  4. O Groene2
  1. 1Clinical Effectiveness Unit, Royal College of Surgeons of UK
  2. 2Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
  3. 3Cambridge Oesophago-Gastric Centre, Addenbrookes Hospital, Cambridge, UK

Abstract

Introduction Centralisation of Oesophagogastric (OG) services were recommended in 2001, with centres serving a minimum population of 1 million.1Key recommendations were that cancer networks should be established with specialist centres performing curative surgery within each network, with a system of coordination between the specialist centres and other hospitals within the network. An overview of the impact of centralisation on the number of trusts, trust volume and mortality at the national level has not been done so far.

Method We used the administrative data set Hospital Episode Statistics (HES) to determine the changes in numbers of trusts and trust volume from 2003 to 2013. Postoperative outcome of surgery (30 day and 90 day mortality) were determined from HES data linked to Office of National Statistics (ONS) data.

Results We analysed data on 29,205 O-G operations. There was a steady decline in the number of trusts performing surgery and an increase in the median volume of patients in the trust from 2003 to 2013. There were 113 trusts performing surgery in 2003 which declined to 43 in 2013 with a corresponding increase in median volume of patients from 21 to 55. Mortality after 30 days and 90 days of surgery were 7.4% and 11.3% in 2003 which decreased to 2.5% and 4.6% in 2013 (Figure 1). The distribution of patient age and gender remained constant over time, but the proportion of oesophageal tumours increased from 55.0% in 2003 to 64.4% in 2013.

Conclusion This is the first description of the changes in number of trusts and median trust volume that occurred from 2003 to 2013 at the national level using administrative data. There has been a reduction in the number of operating trusts and trust volume from 2003 to 2013 with better outcomes being achieved. Our data shows that the policy directive advocating a model of care involving centralised services has been successful in achieving the desired result in terms of better patient care.

Disclosure of interest None Declared.

Reference

  1. Department of Health: Guidance on commisioning cancer services:Improving outcomes in upper gastrointestinal cancers. London: Department of Health, 2001

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