Outcomes After Resection of Hepatocellular Carcinoma: Intersection of Travel Distance and Hospital Volume
Outcomes After Resection of Hepatocellular Carcinoma: Intersection of Travel Distance and Hospital Volume
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DOI：
10.1007/s11605-019-04233-w
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发表时间：
2019-07-01
影响因子：
3.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Beal, Eliza W.;Mehta, Rittal;Pawlik, Timothy M.
背景关于腹部大手术后医院容量和旅行距离对患者预后的影响的数据仍不明确。我们试图描述行肝细胞癌手术切除患者的出行距离、医院容量和远期预后的关系。方法使用2004-2015年国家肿瘤数据库来确定行肝细胞癌切除患者。根据出行距离和住院量四分位数对患者进行分层，用多元回归模型分析出行距离、出院量、出行距离/出院量对总生存率的影响。结果在12266例患者中，楔形/节段性切除(N=7354，59.9%)、半肝切除(N=4003，32.6%)、扩大肝切除(N=909，7.5%)。将数据分层为四分位数，到外科护理的旅行距离分别为5.7英里、5.7-14.2英里、14.2-44.4英里和44.4英里，而医院水平确定的医院容量四分位数分别为每年1例、1.1-4例、4.1-12.5例和12.5例。在多变量分析中，医院容量的增加与死亡率的降低相关(HR 0.69，95%CI 0.45-0.82，p
BackgroundData on the impact of hospital volume and travel distance on patient outcomes after major abdominal surgery remain poorly defined. We sought to characterize the relationship of travel distance, hospital volume, and long-term outcomes of patients undergoing surgical resection of hepatocellular carcinoma (HCC).MethodsThe 2004-2015 National Cancer Database was used to identify patients who underwent resection of HCC. Patients were stratified according to travel distance and hospital volume quartiles, and multivariable regression models were utilized to examine the impact of travel distance, hospital volume, and travel distance/hospital volume on overall survival (OS).ResultsAmong the 12,266 patients identified, procedures included wedge/segmental resections (N=7354, 59.9%), hemi-hepatectomy (N=4003, 32.6%), and extended hepatectomy (N=909, 7.5%). Stratifying data into quartiles, travel distance to surgical care was 5.7miles (mi), >5.7-14.2mi, >14.2-44.4mi, and 44.4mi, while hospital volume quartiles determined on the hospital level were 1 case per year, 1.1-4, 4.1-12.5, and 12.5. On multivariable analysis, increased hospital volume was associated with decreased hazard of mortality (HR 0.69, 95% CI 0.45-0.82, p