Quality of care in advanced ovarian cancer: The importance of provider specialty
Quality of care in advanced ovarian cancer: The importance of provider specialty
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DOI：
10.1016/j.ygyno.2009.12.033
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发表时间：
2010-04-01
影响因子：
4.7
通讯作者：
Ko, Clifford Y.
中科院分区：
文献类型：
--
作者：
Mercado, Cheryl;Zingmond, David;Ko, Clifford Y.
背景卵巢癌治疗的基石之一是细胞减灭术，可以由受过不同专业培训的外科医生进行。我们研究了外科医生的专业是否会影响晚期卵巢癌患者的生活质量（以造口术的存在为代表）和总生存率。IIIC/IV期卵巢癌患者使用4个州癌症登记处确定：加州、华盛顿、纽约和佛罗里达，并将记录链接到相应的住院患者出院文件、AMA主文件和2000年美国人口普查SF 4文件。接受普通外科医生的护理和建立粪便造口术的预测因素进行了分析。进行多变量建模以评估医院容量（低容量（LV）[0-4例]、中等容量（MV）[5-9例]、高容量（HV）[10-19例]和极高容量（VHV）[20+例]）和外科医生专业培训（妇科肿瘤学家/妇科医生、普通外科医生和其他专业）与生存率的相关性。我们确定了31，897例IIIC/IV期患者;平均年龄为64岁。普通外科医生治疗患者的预测LV，农村患者居住地，贫困和高水平的合并症。与LV相比，在高容量医院接受治疗的患者死亡风险较低[VHV风险比（HR）= 0.79，P
Background. One of the cornerstones of ovarian cancer therapy is cytoreductive surgery, which can be performed by surgeons with different specialty training. We examined whether surgeon specialty impacts quality of life (as proxied by presence of ostomy) and overall survival for women with advanced ovarian cancer.Methods. Stage IIIC/IV ovarian cancer patients were identified using 4 state cancer registries: California, Washington, New York, and Florida and linked records to the corresponding inpatient-hospital discharge file, AMA Masterfile, and 2000 U.S. Census SF4 File. Predictors of receipt of care by a general surgeon and creation of fecal ostomy were analyzed. Multivariate modeling was performed to assess the association of hospital volume (low volume (LV) [0-4 cases], middle volume (MV) [5-9], high volume (HV) [10-19], and very high volume (VHV) [20+]) and surgeon specialty training (gynecologic oncologists/gynecologists, general surgeons, and other specialty) on survival.Results. We identified 31,897 Stage IIIC/IV patients; mean age was 64 years. Treatment of patients by a general surgeon was predicted by LV, rural patient residence, poverty, and high level of comorbidity. Patients had lower hazard of death when treated in higher volume hospitals as compared to LV [VHV hazard ratio (HR) = 0.79, P