Changes in clinical outcomes from EMR before and after threshold in RA-CUSUM curve analysis for patients with cancer by (A) annual endoscopist volume and (B) annual hospital volume
| Variable | Volume threshold per year | Overall rate | Below | Above | p Value |
|---|---|---|---|---|---|
| Endoscopist annual volume | |||||
| Emergency intervention | 1 case | 0.6% (0.3% to 1.3%) | 1.8% (0.8% to 3.9%) | 0.1% (0.0% to 0.7%) | 0.002 |
| 30-day mortality | 2 cases | 3.1% (2.2% to 4.3%) | 6.1% (4.3% to 8.5%) | 0.4% (0.1% to 1.3%) | <0.001 |
| 90-day mortality | 2 cases | 6.8% (5.4% to 8.4%) | 12.0% (9.4% to 15.1%) | 2.1% (1.2% to 3.7%) | <0.001 |
| Re-intervention | 8 cases | 23.6% (21.1% to 26.8%) | 24.2% (21.1% to 27.3%) | 17.5% (13.5% to 22.2%) | 0.033 |
| Hospital annual volume | |||||
| Emergency intervention | 5 cases | 0.6% (0.3% to 1.3%) | 1.6% (0.7% to 3.6%) | 0.3% (0.1% to 1.0%) | 0.016 |
| 30-day mortality | 8 cases | 3.1% (2.2% to 4.3%) | 5.3% (3.6% to 7.7%) | 1.2% (0.6% to 2.4%) | <0.001 |
| 90-day mortality | 8 cases | 6.8% (5.4% to 8.4%) | 10.8% (8.3% to 13.8%) | 3.4% (2.2% to 5.2%) | <0.001 |
| Re-intervention | No curve | 23.6% (21.1% to 26.8%) | NA | NA | NA |
Emergency intervention was defined as an acute emergency operation or endoscopic stent insertion performed within 14 days of the primary EMR procedure.
Re-intervention was defined as repeat EMR, oesophagectomy or gastrectomy for the treatment of cancer at least 30 days following the initial EMR procedure.
EMR, endoscopic mucosal resection; RA-CUSUM, risk-adjusted cumulative sum.