University hospital status and gastric cancer mortality - a population-based nationwide study in Finland.

Abstract

Background: Gastric cancer remains a significant global health issue with rising mortality, despite advancements in treatment. Previous studies suggest that surgery performed in university hospitals may influence surgical outcomes and mortality rates, but evidence on its impact for gastric cancer remains limited. This study investigated whether gastrectomy performed at university hospitals reduce short-term and long-term mortality in Finland.

Methods: This nationwide population-based retrospective cohort study analysed gastric cancer patients who underwent gastrectomy in Finland from 1987 to 2016, using data from the Finnish Cancer Registry, Finnish Patient Registry, and Finnish Death Registry. The study compared 5-year, 30-day, and 90-day all-cause mortality between patients treated at university hospitals vs non-university hospitals, with adjustments for confounders using multivariable Cox regression models.

Results: Out of 10,455 patients who underwent gastrectomy in Finland between 1987 and 2016, most were treated in non-university hospitals. Patients undergoing gastrectomy in university hospitals were generally younger, with more comorbidities and more advanced cancer stages. Survival rates were higher in university hospitals, with 30-day, 90-day, and 5-year survival rates being better compared to non-university hospitals, although the differences in 90-day and 5-year survival were not statistically significant in more recent years.

Conclusion: The study suggests that gastrectomy performed at university hospitals in Finland is associated with lower short-term and long-term mortality compared to non-university hospitals. The findings support the potential benefits of centralizing gastric cancer surgeries at university hospitals, but further research is needed to explore the underlying reasons.

Data sharing statement: All presented data are available from THL/Findata, Finland. Data access to collaboration can be granted given that relevant government and health officials approve the collaborative study.