Hospital surgical volume, utilization, costs and outcomes of retroperitoneal lymph node dissection for testis cancer.
Hospital surgical volume, utilization, costs and outcomes of retroperitoneal lymph node dissection for testis cancer.
复制标题
DOI：
10.1155/2012/189823
复制
发表时间：
2012
影响因子：
1.4
通讯作者：
Hu JC
中科院分区：
文献类型：
--
作者：
Yu HY;Hevelone ND;Patel S;Lipsitz SR;Hu JC
目标。睾丸癌的腹膜后淋巴结清扫术（RPLND）结果主要来自单中心系列。我们描述了基于人群的利用、成本和结果，并评估了较高的数量是否会影响结果。方法和材料。使用 2001 年至 2008 年的美国全国住院患者样本，我们确定了 993 名 RPLND，并使用倾向评分方法根据医院手术量评估利用率、成本和住院结果。结果。 51.6% 的 RPLND 是在每年病例数为 2 例或更少的医院进行的。 RPLND 在大型城市教学医院更常见，那里的男性更年轻，更有可能是白人，收入超过第 50 个百分位（所有 P ≤ .05）。较高的住院量与较少的并发症和更多的常规出院相关（所有 P ≤ .047）。然而，流量较大的医院输血量较多 (P = .004)，中位费用多出 1,435 美元 (P < .001)。局限性包括无法根据肿瘤特征进行调整以及缺乏门诊结果。结论。高容量和低容量 RPLND 医院之间存在社会人口统计学差异。尽管容量较大的医院输血量较多且费用较高（可能是由于病例较复杂），但并发症较少。然而，大多数 RPLND 是在每年病例数为 2 例或更少的医院进行的。
Objectives. Retroperitoneal lymph node dissection (RPLND) outcomes for testis cancer originate mostly from single-center series. We characterized population-based utilization, costs, and outcomes and assessed whether higher volume affects outcomes. Methods and Materials. Using the US Nationwide Inpatient Sample from 2001–2008, we identified 993 RPLND and used propensity score methods to assess utilization, costs, and inpatient outcomes based on hospital surgical volume. Results. 51.6% of RPLND were performed at hospitals where there were two or fewer cases per year. RPLND was more commonly performed at large urban teaching hospitals, where men were younger, more likely to be white and earning incomes exceeding the 50th percentile (all P ≤ .05). Higher hospital volumes were associated with fewer complications and more routine home discharges (all P ≤ .047). However, higher volume hospitals had more transfusions (P = .004) and incurred $1,435 more in median costs (P < .001). Limitations include inability to adjust for tumor characteristics and absence of outpatient outcomes. Conclusions. Sociodemographic differences exist between high versus low volume RPLND hospitals. Although higher volume hospitals had more transfusions and higher costs, perhaps due to more complex cases, they experienced fewer complications. However, most RPLND are performed at hospitals where there were two or fewer cases per year.