Who Receives Their Complex Cancer Surgery at Low-Volume Hospitals?
Who Receives Their Complex Cancer Surgery at Low-Volume Hospitals?
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DOI：
10.1016/j.jamcollsurg.2011.10.003
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发表时间：
2012-01-01
影响因子：
5.2
通讯作者：
Habermann, Elizabeth B.
中科院分区：
文献类型：
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作者：
Al-Refaie, Waddah B.;Muluneh, Binyam;Habermann, Elizabeth B.
背景：以往的文献一直显示，在低容量医院（LVH）进行复杂的癌症手术后，手术结局较差。患者相关因素是否影响这种关联仍不清楚。我们假设患者相关因素有助于在LVH接受复杂的癌症手术。研究设计：使用2003-2008年全国住院患者样本，我们确定了59，841名接受肺、食道和胰腺肿瘤癌症手术的患者。Logistic回归模型被用来研究社会人口因素的影响，在LVH.RESULTS接受复杂的癌症手术：总体而言，38.4%的癌症手术在LVH。在LVH时进行食管切除术的比例较高（70.3%），其次是胰腺切除术（38.2%）和肺切除术（33.8%）。非白人、非私人保险、合并症较多的患者更有可能在LVH接受癌症手术（所有患者，p < 0.05）。多变量分析继续表明，非白人种族，保险状况，增加的合并症，地区，和非择期入院预测收到的癌症手术在LVH在所有3 procedure.CONCLUSIONS：在这个大型的国家研究，非白人种族和增加的合并症导致收到的癌症手术在LVH。患者选择和进入高容量医院可能是值得进一步调查的原因。这项研究提供了额外的洞察量的结果的关系。鉴于高容量医院和LVH之间已证明的结果差异，未来的政策和研究应鼓励将癌症患者转诊到高容量医院进行手术治疗的机制。（美国科尔外科杂志2012;214：81-87。(C)2012年美国外科医生学会）
BACKGROUND: Previous literature has consistently shown worse operative outcomes at low-volume hospitals (LVH) after complex cancer surgery. Whether patient-related factors impact this association remains unknown. We hypothesize that patient-related factors contribute to receipt of complex cancer surgery at LVH.STUDY DESIGN: Using the 2003-2008 National Inpatient Sample, we identified 59,841 patients who underwent cancer operations for lung, esophagus, and pancreas tumors. Logistic regression models were used to examine the impact of sociodemographic factors on receipt of complex cancer surgery at LVH.RESULTS: Overall, 38.4% received their cancer surgery at LVH. A higher proportion of esophagectomies were performed at LVH (70.3%), followed by pancreatectomy (38.2%) and lung resection (33.8%). Patients who were non-white, with non-private insurance, and had more comorbidities were all more likely to receive their cancer surgery at LVH (for all, p < 0.05). Multivariate analyses continued to demonstrate that non-white race, insurance status, increased comorbidities, region, and nonelective admission predicted receipt of cancer surgery at LVH across all 3 procedures.CONCLUSIONS: In this large national study, non-white race and increased comorbidities contributed to receipt of cancer surgery at LVH. Patient selection and access to high-volume hospitals are likely reasons worthy of additional investigation. This study provides additional insight into the volume-outcomes relationship. Given the demonstrated outcomes disparity between high-volume hospitals and LVH, future policy and research should encourage mechanisms for referral of patients with cancer to high-volume hospitals for their surgical care. (J Am Coll Surg 2012;214:81-87. (C) 2012 by the American College of Surgeons)