Hospital Variation in 30-Day Mortality After Colorectal Cancer Surgery in Denmark The Contribution of Hospital Volume and Patient Characteristics
Hospital Variation in 30-Day Mortality After Colorectal Cancer Surgery in Denmark The Contribution of Hospital Volume and Patient Characteristics
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DOI：
10.1097/sla.0b013e318207556f
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发表时间：
2011-04-01
影响因子：
9
通讯作者：
Frederiksen, Birgitte
中科院分区：
文献类型：
--
作者：
Osler, Merete;Iversen, Lene H.;Frederiksen, Birgitte
目的：本研究调查了丹麦结直肠癌（CRC）手术后30天死亡率在医院之间的差异，并探讨了医院容量和患者特征是否会导致医院之间的任何差异。背景：关于CRC手术后30天死亡率在医院之间的差异，以及治疗和患者特征可能导致这种差异的影响，我们知之甚少。医院的变化进行了量化，使用多层次的方法，数据来自全国数据库的所有腺癌的结肠和直肠诊断在丹麦在2001年至2004年。这些数据与几个提供患者社会经济地位、合并症和药物使用信息的中央登记处相关联。总共有11，287名患者在43个外科部门中的任何一个进行了手术。医院在急诊结肠癌手术后30天死亡率从3.5%到44.1%不等，多水平分析显示急诊患者为5倍[OR = 4.6]与最好的医院相比，最差的医院在30天内死亡的可能性是一样的。美国麻醉医师协会（阿萨）评分增加了医院之间的变异（OR = 5.8），而其他潜在的解释变量对变异没有影响。对于结肠癌和直肠癌择期手术的患者，医院之间的30天死亡率的变化是小的和nonsignificant.Conclusion：医院CRC手术后30天死亡率的变化是由于医院的能力，以照顾急诊患者的差异，特别是那些阿萨评分高。
Objective: This study examines variation between hospitals in 30-day mortality after surgery for colorectal cancer (CRC) in Denmark and explores whether hospital volume and patient characteristics contribute to any variation between hospitals.Background: Little is known about the variation between hospitals in 30-day mortality after CRC surgery, and the impact of treatment and patient characteristics that might contribute to such variation.Methods: Hospital variation was quantified using a multilevel approach on data derived from a nationwide database of all adenocarcinomas of colon and rectum diagnosed in Denmark in 2001 to 2004. These data were linked to several central registers providing information on patient's socioeconomic status, comorbidity, and use of medication. In total 11,287 patients, who underwent surgery at any of the 43 surgical departments were included.Results: Hospitals varied from 3.5% to 44.1% in 30-day mortality after emergency colon cancer surgery, and the multilevel analysis showed that emergency patients were 5 times [odd ratio (OR) = 4.6)] as likely to die within 30 days in hospitals with the worst performance compared to those with the best performance. The American Society of Anesthesiologists (ASA) score increased the variation between hospitals (OR = 5.8), whereas the other potential explanatory variables had no effect on the variation. For patients who had elective surgery for colon and rectal cancer the variation in 30-day mortality between hospitals was small and nonsignificant.Conclusion: Hospital variation in 30-day mortality after CRC surgery are due to differences in hospitals' ability to take care of emergency patients, especially those with high ASA scores.