Relation of hospital volume to colostomy rates and survival for patients with rectal cancer
Relation of hospital volume to colostomy rates and survival for patients with rectal cancer
复制标题
DOI：
10.1093/jnci/95.10.708
复制
发表时间：
2003-05-21
期刊：
影响因子：
--
通讯作者：
Ayanian, JZ
中科院分区：
文献类型：
--
作者：
Hodgson, DC;Zhang, W;Ayanian, JZ
背景：某些类型的癌症手术后的术后死亡率与医院进行的手术数量呈负相关（即，医院容量）。本研究评估了加州癌症登记处确定的一个大型代表性队列中直肠癌患者的医院容量与结肠造口率和生存率的相关性。研究方法：我们确定了从1994年1月1日至1997年12月31日诊断为I-III期直肠癌并接受手术切除的7257例患者。登记数据与1990年美国人口普查的出院摘要和邮政编码水平数据相关联。采用Mantel-Haenszel趋势检验和Logistic回归分析，评估住院量与永久性结肠造口和30天死亡率之间的关系。采用Kaplan-Meier法和多变量考克斯比例风险模型对总生存期进行了分析。多变量分析调整了人口统计学和临床变量以及医院内的患者聚集。所有统计学显著性检验均为双侧检验。结果如下：在未调整的分析中，在医院容量递减的四分位数中，我们观察到结肠造口术率在统计学上显著增加（29.5%，31.8%，35.2%和36.6%; P
Background: Postoperative mortality after some types of cancer surgery is inversely related to the number of operations performed at a hospital (i.e., hospital volume). This study assessed the association of hospital volume with colostomy rates and survival for patients with rectal cancer in a large representative cohort identified from the California Cancer Registry. Methods: We identified 7257 patients diagnosed from January 1, 1994, through December 31, 1997, with stage I-III rectal cancer who underwent surgical resection. Registry data were linked to hospital discharge abstracts and ZIP-code-level data from the 1990 U.S. Census. Associations of hospital volume with permanent colostomy and 30-day mortality were assessed with the Mantel-Haenszel trend test and logistic regression. Overall survival was examined with the Kaplan-Meier method and a multivariable Cox proportional hazards model. Multivariable analyses adjusted for demographic and clinical variables and patient clustering within hospitals. All tests of statistical significance were two-sided. Results: In unadjusted analyses across decreasing quartiles of hospital volume, we observed statistically significant increases in colostomy rates (29.5%, 31.8%, 35.2%, and 36.6%; P