Impact of hospital volume on operative mortality for major cancer surgery
Impact of hospital volume on operative mortality for major cancer surgery
复制标题
DOI：
10.1001/jama.280.20.1747
复制
发表时间：
1998-11-25
影响因子：
120.7
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Begg, CB;Cramer, LD;Brennan, MF
背景。-在选定的外科肿瘤手术中治疗相对较高数量的患者的医院报告的外科住院死亡率低于手术数量较少的医院，但这些报告没有考虑住院时间或根据病例组合进行调整。目的：在调整病例组合后，确定医院数量是否与30天手术死亡率成反比。设计和设置。-使用监测、流行病学和最终结果(SEER)的回溯性队列研究-医疗保险链接的数据库，其中假设是前瞻性的。外科医生预先确定了外科肿瘤学程序，对于这些程序，治疗更多患者的经验最有可能带来可能抵消手术死亡的知识或技术专长。患者。-SEER登记中被诊断为癌症的所有5013名年龄在65岁或以上的患者接受了胰腺切除、食道切除、全肺切除、肝切除或盆腔清扫术，使用的是1984至1993年间确诊的胰腺癌、食道癌、肺癌、结肠癌和直肠癌以及各种泌尿生殖系癌症。主要结果衡量标准。-30天死亡率与程序量的关系，调整了合并疾病、患者年龄、结果：胰腺切除(P=0.004)、食道切除(P=0.004)、食道切除(P
Context.-Hospitals that treat a relatively high volume of patients for selected surgical oncology procedures report lower surgical in-hospital mortality rates than hospitals with a low volume of the procedures, but the reports do not take into account length of stay or adjust for case mix.Objective.-To determine whether hospital volume was inversely associated with 30-day operative mortality, after adjusting for case mix.Design and Setting.-Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in which the hypothesis was prospectively specified. Surgeons determined in advance the surgical oncology procedures for which the experience of treating a larger volume of patients was most likely to lead to the knowledge or technical expertise that might offset surgical fatalities.Patients.-All 5013 patients in the SEER registry aged 65 years or older at cancer diagnosis who underwent pancreatectomy, esophagectomy, pneumonectomy, liver resection, or pelvic exenteration, using incident cancers of the pancreas, esophagus, lung, colon, and rectum, and various genitourinary cancers diagnosed between 1984 and 1993.Main Outcome Measure.-Thirty-day mortality in relation to procedure volume, adjusted for comorbidity, patient age, and cancer stage.Results.-Higher volume was linked with lower mortality for pancreatectomy (P=.004), esophagectomy (P