Horowitz M M, Przepiorka D, Champlin R E, Gale R P, Gratwohl A, Herzig R H, Prentice H G, Rimm A A, Ringdén O, Bortin M M
Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.
Blood. 1992 May 15;79(10):2771-4.
There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in first chronic phase) to determine whether transplant outcome differed in small and large centers. Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment-related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. Among patients receiving transplants in centers performing more than five transplants a year, there was no statistically significant correlation between number of transplants and outcome.
有大量证据表明，医院的医疗程序数量与死亡率呈负相关。我们分析了1313例接受 HLA 相同同胞骨髓移植治疗早期白血病（首次缓解期的急性白血病或慢性期的慢性粒细胞白血病）患者的数据，以确定大小不同的中心移植结果是否存在差异。移植手术在1983年至1988年间活跃的86个参与国际骨髓移植登记处的骨髓移植中心进行。在研究期间，21个（24%）中心每年进行5例或更少的同种异体移植；5个（6%）中心每年进行超过40例。在对患者和疾病特征差异进行调整后，每年进行5例或更少移植的中心接受移植的患者，其治疗相关死亡率（1.53，P＜0.01）和治疗失败率（1.38，P＜0.04）的相对风险高于大型中心的患者。在每年进行超过5例移植的中心接受移植的患者中，移植数量与结果之间无统计学显著相关性。
