Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Laryngoscope. 2011 Apr;121(4):746-52. doi: 10.1002/lary.21456.
To evaluate the impact of surgeon and hospital case volume and other related variables on short-term outcomes after surgery for oropharyngeal cancer.
The Maryland Health Service Cost Review Commission database was queried for oropharyngeal cancer surgical case volumes from 1990 to 2009. Multivariable regression models were used to identify significant associations between surgeon and hospital case volume, as well as independent variables predictive of in-hospital death, postoperative wound complications, length of hospitalization, and hospital-related cost of care.
Overall, 1,534 oropharyngeal cancer surgeries were performed during the study period. Complete financial data was available for 1,482 oropharyngeal cancer surgeries, performed by 233 surgeons at 36 hospitals. The only independently significant factors associated with the risk of in-hospital death were an APR-DRG mortality risk score of 4 (odds ratio [OR] = 14.0, P < .001) and total glossectomy (OR = 5.6, P = .020). Wound fistula or dehiscence was associated with an increased mortality risk score (OR = 5.9, P < .001), total glossectomy (OR = 6.9, P < .001), mandibulectomy (OR = 3.4, P < .001), and flap reconstruction (OR = 2.1, P = .038). Increased mortality risk score, total glossectomy, pharyngectomy, mandibulectomy, flap reconstruction, neck dissection, and Black race were associated with an increased length of stay and hospital-related costs. After controlling for all other variables, a statistically significant negative correlation was observed between surgery at a high-volume hospital and length of hospitalization and hospital-related costs.
After controlling for other factors, high-volume hospital care is associated with a shorter length of hospitalization and lower hospital-related cost of care for oropharyngeal cancer surgery.
评估外科医生和医院手术量以及其他相关变量对接受口咽癌手术患者短期预后的影响。
检索马里兰州医疗服务成本审查委员会数据库，获取 1990 年至 2009 年期间的口咽癌手术量。采用多变量回归模型，确定外科医生和医院手术量与住院死亡、术后伤口并发症、住院时间和与医院相关的护理费用之间存在显著关联的变量。
研究期间共实施了 1534 例口咽癌手术。共有 1482 例口咽癌手术（由 36 家医院的 233 名外科医生完成）可获得完整的财务数据。唯一与住院死亡风险显著相关的独立因素是 APR-DRG 死亡率风险评分 4 分（比值比[OR] = 14.0，P <.001）和全舌切除术（OR = 5.6，P =.020）。伤口瘘或裂开与死亡率风险评分增加（OR = 5.9，P <.001）、全舌切除术（OR = 6.9，P <.001）、下颌骨切除术（OR = 3.4，P <.001）和皮瓣重建（OR = 2.1，P =.038）相关。死亡率风险评分增加、全舌切除术、咽切除术、下颌骨切除术、皮瓣重建、颈部清扫术和黑人种族与住院时间延长和与医院相关的费用增加相关。在控制所有其他变量后，高手术量医院与住院时间和与医院相关的住院费用之间存在统计学上显著的负相关。
在控制其他因素后，高手术量医院对口咽癌手术的住院时间和与医院相关的护理费用较低。
