Department of Surgery, Johns Hopkins School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA.
J Am Coll Surg. 2009 Dec;209(6):720-6. doi: 10.1016/j.jamcollsurg.2009.09.011.
Multiple reports have demonstrated pancreatic cancer patients undergoing surgery have superior outcomes at high-volume hospitals. This study noted trends in access to high-volume centers for pancreatic resection and identified gaps in improving access.
We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS 2000 to 2005) linked to the Area Resource File (ARF). Inclusion criteria were patients with primary diagnosis of pancreatic cancer who received pancreatic resection. The primary outcomes variable was treatment at high-volume hospitals (average annual case volume greater than 20). Independent variables included age, gender, race, Charlson Comorbidity Index score, insurance status, calendar year, and region, obtained from the Nationwide Inpatient Sample; community poverty level and density of all physicians, gastroenterologists, surgeons, and radiation oncologists were data obtained from the Area Resource File.
A total of 8,370 patients were identified. A minority (38.51%) were referred to high-volume hospitals. A significant increase in overall referral and odds of referral to a high-volume center was observed over time (22.2% in 2000 to 44.4% in 2005). Patients referred to high-volume centers were younger (61.9 versus 63.2 years, p < 0.001) and more likely to be Caucasian (81.7% versus 73.6%, p < 0.001). Patients greater than 85 years old, African Americans, Hispanics, and Asians were less likely to be referred, relative to their younger, Caucasian counterparts (p < 0.01). The overall trend toward improved referral over time was driven by improved referral among Caucasians. In multivariate analysis, access to high-volume centers was associated with calendar year, patient age, and race. In addition, increase in density of gastroenterologists or radiation oncologists in the population was also associated with higher likelihood of referral.
This study demonstrated that less than half of pancreatic cancer patients are being referred to high-volume centers. Unlike referral in Caucasians, improvement in referral for minorities has not occurred.
多项报告表明，在高容量医院接受手术的胰腺癌患者的治疗效果更好。本研究记录了接受胰腺切除术的患者前往高容量中心的趋势，并发现了改善这种情况的差距。
我们对全国住院患者样本（2000 年至 2005 年）进行了回顾性分析，并与地区资源文件（ARF）进行了关联。纳入标准是患有原发性胰腺癌且接受胰腺切除术的患者。主要结局变量是在高容量医院进行治疗（平均每年病例量超过 20 例）。从全国住院患者样本中获得的自变量包括年龄、性别、种族、Charlson 合并症指数评分、保险状况、日历年度和地区；从地区资源文件中获得的社区贫困水平和所有医生、胃肠病学家、外科医生和放射肿瘤学家的密度。
共确定了 8370 名患者。只有少数（38.51%）患者被转介到高容量医院。随着时间的推移，总体转介率和转介到高容量中心的几率显著增加（2000 年为 22.2%，2005 年为 44.4%）。被转介到高容量中心的患者年龄较小（61.9 岁与 63.2 岁，p<0.001），并且更有可能是白人（81.7%与 73.6%，p<0.001）。与年龄较小的白人患者相比，年龄大于 85 岁、非裔美国人、西班牙裔和亚洲人被转介的可能性较小（p<0.01）。随着时间的推移，总体转介率提高的趋势是由白人的转介改善驱动的。在多变量分析中，是否能够转介到高容量中心与日历年度、患者年龄和种族有关。此外，人群中胃肠病学家或放射肿瘤学家的密度增加也与转介的可能性增加有关。
本研究表明，只有不到一半的胰腺癌患者被转介到高容量中心。与白人患者不同，少数民族的转介改善情况尚未发生。
