Kim So Young, Park Jong Hyock, Kim Sung Gyeong, Woo Hye Kyung, Park Jae Hyun, Kim Yoon, Park Eun Cheol
National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, Republic of Korea.
Ann Surg Oncol. 2010 Nov;17(11):2806-15. doi: 10.1245/s10434-010-1133-x. Epub 2010 Jun 10.
Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals.
Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals.
A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58).
We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.
对于已证明存在手术量-预后关系的癌症手术，推荐转诊至高手术量医院。然而，关于癌症手术选择高手术量医院的相关因素知之甚少。本研究的目的是确定在高手术量医院接受肿瘤手术的患者特征。
数据来自提交给韩国国民健康保险系统的理赔申请。我们确定了2002年至2005年间接受以下手术的患者：食管切除术、胰腺切除术、胃切除术、结肠切除术、肺切除术、乳房切除术和膀胱切除术。每家医院的手术量分为三个等级。对患者的人口统计学、社会经济和临床变量进行调查，作为可能影响高手术量或低手术量医院使用的因素。
共有49897名患者接受了七种手术中的一种。所有手术在高手术量医院的手术风险均呈降低趋势。年龄较大（比值比[OR]，0.60 - 0.69）、居住在农村地区（OR，0.79）、接受急诊手术（OR，0.39 - 0.85）以及Charlson评分较低的患者前往高手术量医院的可能性较小。对于所有手术，与收入水平最高的患者相比，收入水平最低的患者在高手术量医院接受治疗的可能性显著降低（OR，0.45 - 0.58）。
我们发现，在所研究的七种手术中，高手术量医院的使用存在显著的人口统计学和社会经济差异。选择性转诊至高手术量医院的政策应包括明确努力，以确定减少当前不平等现象所需的患者和系统因素。
