Kwon Janice S, Carey Mark S, Cook E Francis, Qiu Feng, Paszat Lawrence F
Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston TX.
Department of Systems Biology, MD Anderson Cancer Center, Houston TX.
J Obstet Gynaecol Can. 2007 Dec;29(12):982-987. doi: 10.1016/S1701-2163(16)32691-3.
Wait times for cancer surgery in Ontario have increased over the last decade. We reviewed trends in wait times for endometrial cancer surgery from 1996 to 2000 and identified determinants that may need to be addressed in order to reduce these wait times.
The study population included women diagnosed with endometrial cancer (ICD-9 codes 179 or 182) prior to surgery. Surgical wait time was defined as the interval between date of diagnosis and hospital admission for surgery. Univariate analyses assessed demographic, treatment, and hospital factors associated with wait times. A multilevel linear regression model was created to account for clustering of patients at the hospital level and regional level defined by local health integration networks (LHINs). Effects of covariates were expressed as estimates of the median proportional change in wait time.
There were 2042 cases in this analysis. Mean wait time increased from 32 to 40 days (P = 0.0012). Prolonged wait times were associated with age > 70 years, presence of comorbidities, and surgery performed at a teaching hospital and by a gynaecologic oncologist. Wait times were not associated with income level or region of residence defined by LHIN.
Wait times for endometrial cancer surgery have increased significantly in Ontario. Determinants of these prolonged wait times need to be addressed, and criteria for referral to a teaching hospital and gynaecologic oncologist should be developed to ensure that local health integration networks provide equal and timely access to care.
在过去十年中，安大略省癌症手术的等待时间有所增加。我们回顾了1996年至2000年子宫内膜癌手术等待时间的趋势，并确定了为减少这些等待时间可能需要解决的决定因素。
研究人群包括手术前被诊断为子宫内膜癌（国际疾病分类第九版代码179或182）的女性。手术等待时间定义为诊断日期与手术入院日期之间的间隔。单因素分析评估了与等待时间相关的人口统计学、治疗和医院因素。创建了一个多级线性回归模型，以考虑由当地卫生整合网络（LHINs）定义的医院层面和区域层面患者的聚集情况。协变量的影响以等待时间中位数比例变化的估计值表示。
本分析中有2042例病例。平均等待时间从32天增加到40天（P = 0.0012）。等待时间延长与年龄>70岁、存在合并症以及在教学医院由妇科肿瘤学家进行手术有关。等待时间与收入水平或由LHIN定义的居住地区无关。
安大略省子宫内膜癌手术的等待时间显著增加。需要解决这些延长等待时间的决定因素，并且应该制定转诊到教学医院和妇科肿瘤学家的标准，以确保当地卫生整合网络提供平等且及时的医疗服务。
