Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Determination of Minimum Surgical Caseloads for Major Oncologic Resections Using a Population-Attributable Fraction Model of Observational Data in Germany Publisher Pubmed



Uttinger K1, 2 ; Mansournia MA3 ; Baum P4 ; Diers J5 ; Rust C6, 7 ; Wiegering A1
Authors
Show Affiliations
Authors Affiliations
  1. 1. Department of General, Visceral, and Transplant Surgery, Frankfurt University Hospital, Frankfurt, Germany
  2. 2. Frankfurt Cancer Institute, Georg-Speyer-Haus, Frankfurt, Germany
  3. 3. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
  5. 5. Marienkrankenhaus, Hamburg, Germany
  6. 6. Department of Econometrics, University of Regensburg, Regensburg, Germany
  7. 7. Department of Finance, Accounting and Statistics, Vienna University of Economics and Business, Vienna, Austria

Source: JCO Oncology Practice Published:2025


Abstract

PURPOSE There is a volume-outcome association in cancer surgery; fulfillment of minimum surgical caseloads (MSCs) is known to be associated with reduced in-hospital mortality. To our knowledge, to date, there is no evidence-based approach to determine MSC with regard to in-hospital mortality. METHODS Hospital billing data of pulmonary, esophageal, gastric, pancreatic, colon, and rectal cancer resections were analyzed. Nonfulfillment of annual caseloads of 5-100 procedures was defined as a risk factor of in-hospital mortality in a population-attributable fraction (PAF) model adjusting for age, sex, resection extent, and comorbidity. MSCs were obtained using a linear-trend approach. The primary end point was the fraction of attributable deaths due to nonfulfillment of MSCs. Driving distances to the treating hospital and closest MSC-fulfilling hospital were obtained using geocoding. RESULTS A total of 824,535 patient records were analyzed. Resulting MSCs were 50 in pulmonary, 31 in esophageal, 31 in gastric, 48 in pancreatic, 28 in colon, and 43 per year in rectal resections. The PAF of nonfulfillment of the MSC was lowest in colon resections (8.8%, 95% CI, 1.0% to 16.5%) and highest in pancreatic resections (30.6%, 95% CI, 22.8% to 38.5%). The median difference in the driving distance (to the treating hospital v to MSC-fulfilling hospital) ranged between –3.5 km (IQR, –16.2 km to 10.2 km) in colon resections and 139.1 km (IQR, 10.3 km to 189.5 km) in rectal resections. CONCLUSION A PAF model is feasible in determining MSCs in cancer surgery with regard to in-hospital mortality; differences in driving distances to MSC fulfilling hospitals can be assessed using geocoding. © 2025 by American Society of Clinical Oncology.
Related Docs
View other Related Docs
1. Population Attributable Fraction in Textbooks: Time to Revise, Global Epidemiology (2021)
2. The Causal Effect and Impact of Reproductive Factors on Breast Cancer Using Super Learner and Targeted Maximum Likelihood Estimation: A Case-Control Study in Fars Province, Iran, BMC Public Health (2021)
3. Association of Anti-N and -S Seroprevalence in Asymptom Atic, Mildly Symptomatic, and Symptomatic Sars-Cov-2 Natural Infection, Infection# Epidemiology and Microbiology (2022)
4. Occupational Exposure to Diesel Exhaust and Head and Neck Cancer: A Systematic Review and Meta-Analysis of Cohort Studies, European Journal of Cancer Prevention (2024)
5. Per-And Poly-Fluoroalkyl Substances (Pfas) Exposure and Risk of Kidney, Liver, and Testicular Cancers: A Systematic Review and Meta-Analysis, Medicina del Lavoro (2023)
6. Causal Diagrams for Immortal Time Bias, International Journal of Epidemiology (2021)
7. Plant-Based Diet and Covid-19 Severity: Results From a Cross-Sectional Study, BMJ Nutrition# Prevention and Health (2023)
8. Validity and Reliability of the Persian Version of the World Health Organization Quality of Life Disabilities Module, Journal of Intellectual Disabilities (2022)
Experts (# of related papers)
View all Related Experts
Mohammad Ali Mansournia (7)
Saharnaz Nedjat (4)
Other Related Docs
9. Estimating the Marginal Causal Effect and Potential Impact of Waterpipe Smoking on Risk of Multiple Sclerosis Using the Targeted Maximum Likelihood Estimation Method: A Large, Population-Based Incident Case-Control Study, American Journal of Epidemiology (2021)
10. Longitudinal Effects of Lipid Indices on Incident Cardiovascular Diseases Adjusting for Time-Varying Confounding Using Marginal Structural Models: 25 Years Follow-Up of Two Us Cohort Studies, Global Epidemiology (2022)
11. Comparison of Outcomes Between Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery Using Collaborative Targeted Maximum Likelihood Estimation, Scientific Reports (2024)
12. Effect of Alcohol Consumption on Breast Cancer: Probabilistic Bias Analysis for Adjustment of Exposure Misclassification Bias and Confounders, BMC Medical Research Methodology (2023)
13. The Effect of Smoking on Latent Hazard Classes of Metabolic Syndrome Using Latent Class Causal Analysis Method in the Iranian Population, BMC Public Health (2023)
14. Interaction Between Opium Use and Cigarette Smoking on Bladder Cancer: An Inverse Probability Weighting Approach Based on a Multicenter Case-Control Study in Iran, Global Epidemiology (2025)