Lin Chia-Cheng, Lin Herng-Ching
Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Surgery. 2008 Mar;143(3):343-51. doi: 10.1016/j.surg.2007.09.033. Epub 2007 Dec 21.
Although the relationship between provider volume and treatment outcome has been established for many types of operations, such a relationship has yet to be determined for resection of oral cancers. The purpose of this report is to assess the effects of surgeon and hospital volume on 5-year survival for oral cancer.
A total of 6,666 patients who underwent resections of oral cancer between 1997 and 1999 were identified from the Taiwan National Health Insurance Research Database. These data were linked to the "cause of death" data file from the Department of Health in Taiwan and traced for 5 years to obtain the survival times for individual patients. Survival analysis and proportional hazard regressions were conducted to assess the association between 5-year survival rates and surgeon and hospital volumes after adjusting for patient and provider variables. Volume relationships were based on the following criteria: low-, medium-, and high-volume surgeons were defined by <52, 52 to 142, and >142 resections, respectively, during the 3-year period. Similarly, low-, medium-, and high-volume hospitals were defined by <343, 343 to 531, and >531 resections, respectively, during the 3-year period.
With an increase in individual surgeon volume, there were increases in the unadjusted 5-year survival rates (45.5%, 49%, and 51.8% for low-, medium-, and high-volume groups, respectively; P < .001); no such association, however, was observed with hospital volumes (47.5%, 51.3%, and 49% for low-, medium-, and high-volume hospitals, respectively; P = .074). Compared with treatment by low-volume surgeons, operations by high-volume surgeons were associated with an adjusted hazard ratio of 0.810 (95% confidence interval = 0.735-0.893).
We conclude that, for patients who underwent oral cancer resections, after adjusting for differences in the case mix, high-volume surgeons had better 5-year survival rates. This association, however, was not discernible for high-volume hospitals.
尽管对于多种手术类型，已确定了医疗服务提供者手术量与治疗结果之间的关系，但口腔癌切除术的这种关系尚未确定。本报告的目的是评估外科医生和医院手术量对口腔癌患者5年生存率的影响。
从台湾国民健康保险研究数据库中识别出1997年至1999年间共6666例行口腔癌切除术的患者。这些数据与台湾卫生部门的“死亡原因”数据文件相关联，并追踪5年以获取个体患者的生存时间。在对患者和医疗服务提供者变量进行调整后，进行生存分析和比例风险回归，以评估5年生存率与外科医生和医院手术量之间的关联。手术量关系基于以下标准：低手术量、中等手术量和高手术量的外科医生分别定义为在3年期间手术量<52例、52至142例和>142例。同样，低手术量、中等手术量和高手术量的医院分别定义为在3年期间手术量<343例、343至531例和>531例。
随着个体外科医生手术量的增加，未经调整的5年生存率有所提高（低手术量、中等手术量和高手术量组分别为45.5%、49%和51.8%；P<.001）；然而，未观察到与医院手术量有此类关联（低手术量、中等手术量和高手术量医院分别为47.5%、51.3%和49%；P = 0.074）。与低手术量外科医生的治疗相比，高手术量外科医生的手术调整后风险比为0.810（95%置信区间 = 0.735 - 0.893）。
我们得出结论，对于接受口腔癌切除术的患者，在调整病例组合差异后，高手术量外科医生的5年生存率更高。然而，对于高手术量医院，这种关联并不明显。
