The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer
The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer
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DOI：
10.1067/msy.2002.120238
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发表时间：
2002-01-01
期刊：
影响因子：
3.8
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Hannan, EL;Radzyner, M;Brennan, MF
背景本研究探讨了3组癌症手术量与死亡率的关系，以确定是否高手术量的医院、高手术量的外科医生或两者都与较低的住院死亡率相关。纽约的全州计划和研究合作系统被用来确定超过32,000名住院的癌症诊断患者，他们在1994年1月1日至1997年12月31日期间接受了结肠切除术、肺叶切除术或胃切除术。在调整年龄、人口统计学、器官转移、社会经济状况和合并症的差异后，研究了住院死亡率与提供者（医院和外科医生）数量的相关性。对于胃切除术的住院量，最高手术量的四分位数的绝对风险调整死亡率比最低手术量的四分位数低7.1%（P <0.0001），尽管手术的总体死亡率仅为6.2%。对于外科医生结肠切除术的体积，最高和最低体积四分位数相差1.9%（P
Background. This study explores the volume-mortality relationship for 3 groups of cancer procedures to determine whether higher-volume hospitals, higher-volume surgeons, or both are associated with lower in-hospital mortality.Methods. New York's Statewide Planning and Research Cooperative System was used to identify more than 32,000 hospital inpatients with a cancer diagnosis who underwent colectomy, lobectomy of the lung, or gastrectomy between January 1, 1994, and December 31, 1997. The association of in-hospital mortality rates with provider (hospital and surgeon) volume was examined after adjusting for differences in age, demographics, organ metastasis, socioeconomic status, and comorbidities.Results. For hospital volume for gastrectomy, the highest-volume quartile had an absolute risk-adjusted mortality rate that was 7.1% lower (P < .0001) than the lowest-volume quartile, although the overall mortality rate for the procedure was only 6.2%. For surgeon volume for colectomy, the highest- and lowest-volume quartiles differed by 1.9% (P