Urologist referral delay and its impact on survival after radical cystectomy for bladder cancer
Urologist referral delay and its impact on survival after radical cystectomy for bladder cancer
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DOI：
10.3747/co.22.2052
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发表时间：
2015-02-01
期刊：
影响因子：
2.6
通讯作者：
Aprikian, A.
中科院分区：
文献类型：
--
作者：
Santos, F.;Dragomir, A.;Aprikian, A.
背景证据表明，膀胱癌手术前的等待时间一直在增加，等待时间会对生存产生负面影响。我们的目的是确定是否长期延迟所造成的第一次泌尿科就诊前的间接转诊影响接受根治性膀胱切除术的膀胱cancer.MethodsWe的患者的生存进行了分析，从1271例患者接受手术治疗膀胱癌在2000年至2009年的十年期间的数据。该队列是通过连接魁北克省的两个行政数据库获得的。如果患者在首次泌尿科医生访视前接受过5次或更少的全科医生访视，则认为患者已直接转诊至泌尿科医生;否则，认为患者已间接转诊。术后生存的影响，一个较长的延迟之前，第一次泌尿科医生访问进行了评估，使用考克斯回归models.ResultsMedian转诊延迟为研究人群为30天（女性56天，男性23天，P < 0.0001）。49%的妇女和33%的男子接受了间接转诊。与直接转诊的患者相比，首次出现膀胱癌症状后间接转诊的患者生存率更低（风险比：1.29; 95%置信区间：1.10 - 1.52）。间接转诊的妇女在根治性膀胱切除术后的死亡风险显著增加47%。男性谁是间接提到也经历了生存率下降（调整后的风险比：1.25; 95%置信区间：1.03至1.51）。与男性相比，女性的等待时间更长，生存率更低。
BackgroundEvidence shows that wait times before bladder cancer surgery have been increasing, and wait time can negatively affect survival. We aimed to determine if a long delay caused by an indirect referral before a first urologist visit affects the survival of patients undergoing radical cystectomy for bladder cancer.MethodsWe analyzed data from 1271 patients who underwent surgery for bladder cancer during the decade 2000-2009. The cohort was obtained by linking two administrative databases in the province of Quebec. Patients were considered to have been directly referred to a urologist if they had 5 or fewer visits with a general practitioner before their first urologist visit; otherwise, they were considered to have been indirectly referred. The effect on survival after surgery of a longer delay before a first urologist visit was assessed using Cox regression models.ResultsMedian referral delay for the study population was 30 days (56 days for women, 23 days for men; p < 0.0001). Indirect referral was observed for 49% of women and 33% of men. Compared with patients who were directly referred, those who were indirectly referred after first symptoms of bladder cancer experienced poorer survival (hazard ratio: 1.29; 95% confidence interval: 1.10 to 1.52). Women who were indirectly referred had a significant 47% greater risk of death after radical cystectomy. Men who were indirectly referred also experienced decreased survival (adjusted hazard ratio: 1.25; 95% confidence interval: 1.03 to 1.51).ConclusionsPatients indirectly referred to a urologist had an increased risk of mortality after surgery. Compared with men, women had longer wait times and poorer survival.