The appropriateness of 30-day mortality as a quality metric in colorectal cancer surgery
The appropriateness of 30-day mortality as a quality metric in colorectal cancer surgery
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DOI：
10.1016/j.amjsurg.2017.04.018
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发表时间：
2018-01-01
影响因子：
3
通讯作者：
Mantyh, Christopher R.
中科院分区：
文献类型：
--
作者：
Adam, Mohamed Abdelgadir;Turner, Megan C.;Mantyh, Christopher R.
背景：我们的研究比较了大肠癌手术后30天和90天的死亡率（CRS），并在此基础上检验了医院绩效排名。方法：比较来自国家癌症数据库（2004-2012）的iii期结直肠癌患者在CRS后30天和90天的死亡率。风险调整层次回归模型基于死亡率评估医院绩效。医院被分为高（10%）、中（80%）和低（10%）绩效组。结果：在185,464例患者中，90天死亡率几乎是30天死亡率的两倍（4.4%对2.5%）。风险调整后，176家医院改变了绩效排名：30天死亡率最高组中有39%的医院改变了排名至中间组；在最低30天组中，37%的医院将排名改为中间90天组。结论：基于30天死亡率的医院绩效评估与15%的医院分类错误有关。在肿瘤CRS中，90天死亡率可能是一个更好的质量指标。(C) 2017爱思唯尔公司版权所有。
Background: Our study compares 30-day vs. 90-day mortality following colorectal cancer surgery (CRS), and examines hospital performance ranking based on this assessment.Methods: Mortality rates were compared between 30 vs. 90 days following CRS for patients with stage IIII colorectal cancers from the National Cancer Database (2004-2012). Risk-adjusted hierarchical regression models evaluated hospital performance based on mortality. Hospitals were ranked into top (10%), middle (80%), and lowest (10%) performance groups.Results: Among 185,464 patients, 90-day mortality was nearly double the 30-day mortality (4.4% vs. 2.5%). Following risk adjustment 176 hospitals changed performance ranking: 39% in the top 30-day mortality group changed ranking to the middle group; 37% of hospitals in the lowest 30-day group changed ranking to the middle 90-day group.Conclusions: Evaluation of hospital performance based on 30-day mortality is associated with misclassification for 15% of hospitals. Ninety-day mortality may be a better quality metric in oncologic CRS. (C) 2017 Elsevier Inc. All rights reserved.