基于体积的喉癌手术趋势。

Volume-based trends in laryngeal cancer surgery.

机构信息

Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

出版信息

Laryngoscope. 2011 Jan;121(1):77-84. doi: 10.1002/lary.21393.

DOI:10.1002/lary.21393

PMID:21125633

Abstract

OBJECTIVES

Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of laryngeal cancer surgery by hospital and surgeon volume are poorly defined.

METHODS

The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon laryngeal cancer surgical case volumes from 1990 to 2009.

RESULTS

Overall, 1,981 laryngeal cancer surgeries were performed by 288 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 19% in 1990 to 1999 to 35% in 2000 to 2009 (odds ratio [OR] = 3.0, P<.001), whereas cases performed at high-volume hospitals increased from 33% to 39% (OR = 2.0, P<.001). High-volume surgeons were more likely to perform total laryngectomy (OR = 1.7, P = .001) and neck dissection (OR = 1.7, P = .002). High-volume hospitals were significantly associated with total laryngectomy (OR = 2.0, P = .003), neck dissection (OR = 1.8, P = .038), flap reconstruction (OR = 5.1, P = .021), prior radiation (OR = 3.0, P = .031), and increased mortality risk scores (OR = 3.2, P = .006). After controlling for other variables, laryngeal cancer surgery in 2000 to 2009 was associated with increased access to high-volume surgeons (OR = 1.9, P<.001) and high-volume hospitals (OR = 1.3, P = .040), a decrease in partial and total laryngectomy procedures (OR = 0.2, P<.001), an increase in neck dissection (OR = 2.2, P< 0.001), an increase in prior radiation (OR = 3.0, P<.001), increased case complexity scores (OR = 5.7, P<.001), and an increase in wound fistula or dehiscence (OR = 2.0, P = .015) compared with 1990 to 1999.

CONCLUSIONS

The proportion of laryngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly in 2000 to 2009 compared with 1990 to 1999, with a decrease in laryngectomy procedures and an increase in wound complications. These findings may be due to changing trends in primary management of laryngeal cancer.

摘要

目的

对于采用技术复杂手术治疗的疾病，存在阳性的手术量-结局关系。目前，医院和外科医生喉癌手术量的模式尚不清楚。

方法

从 1990 年至 2009 年，马里兰州医疗服务成本审查委员会数据库对医院和外科医生的喉癌手术病例量进行了查询。

结果

共有 41 家医院的 288 名外科医生共进行了 1981 例喉癌手术。高手术量外科医生进行的手术比例从 1990 年至 1999 年的 19%增加到 2000 年至 2009 年的 35%（优势比[OR]为 3.0，P<.001），而高手术量医院的手术比例从 33%增加到 39%（OR = 2.0，P<.001）。高手术量外科医生更有可能进行全喉切除术（OR = 1.7，P =.001）和颈部清扫术（OR = 1.7，P =.002）。高手术量医院与全喉切除术（OR = 2.0，P =.003）、颈部清扫术（OR = 1.8，P =.038）、皮瓣重建术（OR = 5.1，P =.021）、先前放疗（OR = 3.0，P =.031）和增加的死亡率评分（OR = 3.2，P =.006）显著相关。在控制其他变量后，2000 年至 2009 年的喉癌手术与更多地接触高手术量外科医生（OR = 1.9，P<.001）和高手术量医院（OR = 1.3，P =.040）相关，部分和全喉切除术的比例下降（OR = 0.2，P<.001），颈部清扫术的比例增加（OR = 2.2，P<.001），先前放疗的比例增加（OR = 3.0，P<.001），病例复杂程度评分增加（OR = 5.7，P<.001），以及伤口瘘或裂开的比例增加（OR = 2.0，P =.015），与 1990 年至 1999 年相比。