Management and outcomes in digestive XXXX surgery: design and initial results of a multicenter cohort study.

@entity5 @entity1 @entity418 @entity3
BACKGROUND: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume. OBJECTIVE: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver @entity3 and rectum @entity5 in Catalonia, as well as the factors associated with these variations. @entity1 AND METHOD: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect @entity1 , process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and follow-up mortality, complications, re-interventions, and relapse rates. RESULTS: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 @entity1 (98%) were included. No differences were observed in the profile of operated @entity1 according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of @entity5 and center complexity. High rates of @entity418 mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all @entity5 assessed, especially @entity5 (18.4% re-interventions at 6 months), were identified. CONCLUSIONS: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.
