Higher hospital surgical volume leads to significantly better outcomes for esophagectomy and gastrectomy patients.

• 30-day mortality drops to 51% lower (odds ratio 0.51) at high-volume hospitals performing 4-239 resections/year.
• 90-day mortality reduced by 35% (odds ratio 0.65) and fewer complications observed (odds ratio 0.83).

Surgical teams should consider hospital volume when planning procedures.

• Optimal volume thresholds identified: 43 cases/year for esophagectomy and 15 for gastrectomy, beyond which outcomes plateau.