Yasunaga Hideo, Matsuyama Yutaka, Ohe Kazuhiko
Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Surg Today. 2009;39(8):663-8. doi: 10.1007/s00595-008-3848-x. Epub 2009 Jul 29.
Numerous studies on the volume-outcome relationships in rectal cancer surgery have assessed surgical mortality. However, little is known about the association between hospital/surgeon volumes and postoperative complications, including anastomotic leakage and infection, following rectal cancer surgery.
Using a web-based patient registration system, data were collected on inpatients who underwent rectal cancer surgery between November 1, 2006 and February 28, 2007 in Japan. Using multivariate analyses, intraoperative blood loss, postoperative complications and length of stay were independently compared against the provider volumes and covariates.
No significant association was identified between the blood loss and hospital volume, while surgeons with the highest volume (> or =500 procedures) were likely to demonstrate a reduced blood loss (odds ratio, 0.67; 95% confidence interval, 0.46-0.99; P = 0.043). No significant relationship was found between the incidence of postoperative complications and the provider volume. A higher hospital volume significantly decreased the length of stay (hazard ratio, 1.41; 95% confidence interval, 1.23-1.62; P < 0.01), but the surgeon volume was not associated with the length of hospital stay.
The present study did not find any significant relationship between the volume and postoperative complications. These results do not support the effectiveness of regionalizing rectal cancer surgery to high-volume centers, at least in the Japanese clinical setting.
众多关于直肠癌手术中手术量与预后关系的研究评估了手术死亡率。然而，对于医院/外科医生手术量与直肠癌手术后包括吻合口漏和感染在内的术后并发症之间的关联，人们了解甚少。
利用基于网络的患者登记系统，收集了2006年11月1日至2007年2月28日在日本接受直肠癌手术的住院患者的数据。通过多变量分析，将术中失血量、术后并发症和住院时间分别与医疗服务提供者的手术量及协变量进行独立比较。
失血量与医院手术量之间未发现显著关联，而手术量最高（≥500例手术）的外科医生的失血量可能会减少（优势比为0.67；95%置信区间为0.46 - 0.99；P = 0.
