Barton Michael B, Gabriel Gabriel S, Frommer Michael S, Holt Phoebe E, Thompson John F
The Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Health Service, Liverpool, New South Wales, Australia.
ANZ J Surg. 2006 May;76(5):318-24. doi: 10.1111/j.1445-2197.2006.03717.x.
Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost-ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high-quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined.
Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001-2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined.
During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty-seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0-53%). Eight hundred and fifty-eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0-47%).
Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.
有证据表明，用于治疗癌症的手术类型存在很大差异。这种差异可能导致护理效果欠佳或成本效益低下。本研究调查了在新南威尔士州（NSW）建立黑色素瘤网络以促进更统一的高质量护理之前，黑色素瘤手术治疗的差异情况。研究了新南威尔士州地区卫生服务机构根据患者居住地划分的黑色素瘤手术程序使用差异。
对新南威尔士州卫生信息交换中心收集的2001年7月1日至2002年6月30日期间在新南威尔士州公立和私立医院对诊断为黑色素瘤的患者进行手术的数据进行了检查。数据按患者居住地的地区卫生服务机构进行汇总。将这些数据与2001 - 2002年同一地区向新南威尔士州中央癌症登记处报告的黑色素瘤新病例数进行了比较。检查了皮肤病变切除、皮肤移植以及淋巴结手术的数量和类型。
在研究期间，中央癌症登记处报告有3085例黑色素瘤病例通报，而医院住院患者数据记录显示，新南威尔士州公立和私立医院为诊断为黑色素瘤的患者进行了6864例手术。67%的手术在私立医院进行。共记录了852例皮肤移植手术。其中，60%在私立医院进行。新南威尔士州与切除手术相关的皮肤移植平均比例为30%（范围为0 - 53%）。为747名新南威尔士州居民记录了858例淋巴结手术。这些手术包括活检、切除或两者皆有。40%在私立医院进行。新南威尔士州与淋巴结手术相关的黑色素瘤新病例平均比例为28%（范围为0 - 47%）。
黑色素瘤患者的大多数住院手术在私立医院进行。切除术后进行皮肤移植或接受淋巴结清扫的新病例比例在不同地区卫生服务机构之间相差超过五倍。这可能表明病例组合存在差异、临床实践存在差异或两者皆有。
