Volume-outcome analysis of colorectal cancer-related outcomes
Volume-outcome analysis of colorectal cancer-related outcomes
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DOI：
10.1002/bjs.7111
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发表时间：
2010-09-10
影响因子：
9.6
通讯作者：
Kelly, S. B.
中科院分区：
文献类型：
--
作者：
Borowski, D. W.;Bradburn, D. M.;Kelly, S. B.
背景资料：病例量和手术结果之间的显著关联突出了当地癌症护理和集中化需求之间的冲突。本研究探讨了医院容量的短期结果和生存的影响，调整外科医生的caseroad.Methods的效果：在1998年和2002年之间，8219例结直肠癌患者被确定在一个区域人口为基础的审计。使用单变量和多变量分析评估结局，以调整病例组合。外科医生被分为低（每年26次或更少的手术），中等（27-40）或高（超过40）量。医院被列为低（86或更少）、中等（87-109）或高（超过109）卷。结果：一些7411 8219例患者中有90.2%接受了手术，吻合口瘘发生率为2.9%（5581），围手术期死亡率为8.0%（591/7411）和5年生存率为46.8%。（比值比（OR）分别为0.74，P = 0.010和0.66，P = 0.002）和生存率（风险比（HR）分别为0.88，P = 0.003和-RR 0.93，P = 0.090）。直肠癌的生存率显着更好的高容量与低容量的医院（HR 0.85，P = 0.036），与中等和低容量的医院之间没有差异（HR 0.96，P = 0.505）。结论：这项研究证实了最低容量标准的相关性，为个别外科医生。在高容量单位组织服务可能会提高直肠癌患者的生存率。
Background: Significant associations between caseload and surgical outcomes highlight the conflict between local cancer care and the need for centralization. This study examined the effect of hospital volume on short-term outcomes and survival, adjusting for the effect of surgeon caseload.Methods: Between 1998 and 2002, 8219 patients with colorectal cancer were identified in a regional population-based audit. Outcomes were assessed using univariable and multivariable analysis to allow case mix adjustment. Surgeons were categorized as low (26 or fewer operations annually), medium (27-40) or high (more than 40) volume. Hospitals were categorized as low (86 or fewer), medium (87-109) or high (more than 109) volume.Results: Some 7411 (90.2 per cent) of 8219 patients underwent surgery with an anastomotic leak rate of 2.9 per cent (162 of 5581), perioperative mortality rate of 8.0 per cent (591 of 7411) and 5-year survival rate of 46.8 per cent. Medium- and high-volume surgeons were associated with significantly better operative mortality (odds ratio (OR) 0.74, P = 0.010 and OR 0.66, P = 0.002 respectively) and survival (hazard ratio (HR) 0.88, P = 0.003 and -RR 0.93, P = 0.090 respectively) than low-volume surgeons. Rectal cancer survival was significantly better in high-volume versus low-volume hospitals (HR 0.85, P = 0.036), with no difference between medium- and low-volume hospitals (HR 0.96, P = 0.505).Conclusion: This study has confirmed the relevance of minimum volume standards for individual surgeons. Organization of services in high-volume units may improve survival in patients with rectal cancer.