Division of Surgical Oncology, Department of Surgery, Univ. of Minnesota, Minneapolis, MN, USA.
Ann Surg Oncol. 2012 Feb;19(2):365-72. doi: 10.1245/s10434-011-1973-z. Epub 2011 Aug 12.
Hospital attributes have been shown to impact short- and long-term outcomes after cancer surgery. However, the effect of hospital attributes on processes of cancer care in terms of delivery of guideline recommended care has not been evaluated. We examined the impact of hospital attributes (volume and type) on guideline-recommended care in patients treated for gastric cancer.
We identified patients who were surgically treated for gastric cancer at Commission on Cancer (CoC) hospitals from 2001 to 2006. Patient, tumor, and treatment factors were compared separately by hospital volume and type. Multivariable analyses were used to evaluate the impact of hospital attributes on delivery of guideline recommended gastric cancer care: adequate lymphadenectomy (≥15 lymph nodes), and adjuvant multimodality therapy (for AJCC Ib-IVM0), controlling for covariates.
More than 1,490 CoC hospitals performed 37,124 gastrectomies. High-volume and teaching CoC hospitals were more likely to treat younger patients, non-whites, patients with lower AJCC stage, and to perform adequate lymphadenectomy than low-volume and community CoC hospitals (p ≤ 0.001). Hospital volume and type, however, were not associated with receipt of adjuvant multimodality therapy. These associations persisted in our multivariable analyses to show that CoC hospital attributes were associated with adequate lymphadenectomy, but marginally predictive of receipt of adjuvant multimodality therapy.
The strong association between CoC hospital volume or type and guideline-recommended care diminishes after gastric cancer surgery. Variations in referral, insurance, and documentation patterns are potential explanations for these findings. These results highlight some limitations of using hospital attributes as a sole predictor of optimal cancer care.
医院的属性已被证明会影响癌症手术后的短期和长期结果。然而，尚未评估医院属性对癌症护理过程（即提供指南推荐的护理）的影响。我们研究了医院属性（数量和类型）对接受胃癌治疗的患者的指南推荐护理的影响。
我们从 2001 年至 2006 年确定了在癌症委员会（CoC）医院接受手术治疗的胃癌患者。分别根据医院数量和类型比较了患者、肿瘤和治疗因素。多变量分析用于评估医院属性对指南推荐的胃癌护理（充分的淋巴结清扫术（≥15 个淋巴结）和辅助多模式治疗（对于 AJCC Ib-IVM0）的影响，同时控制了协变量。
超过 1490 家 CoC 医院进行了 37124 例胃切除术。高容量和教学型 CoC 医院更有可能治疗年轻患者、非白人患者、较低 AJCC 分期的患者，并进行充分的淋巴结清扫术，而低容量和社区型 CoC 医院则不然（p≤0.001）。然而，医院数量和类型与接受辅助多模式治疗无关。这些关联在我们的多变量分析中仍然存在，表明 CoC 医院属性与充分的淋巴结清扫术有关，但对接受辅助多模式治疗的预测作用不大。
CoC 医院数量或类型与指南推荐护理之间的强关联在胃癌手术后会减弱。转诊、保险和记录模式的差异可能是这些发现的原因。这些结果强调了仅使用医院属性作为最佳癌症护理的唯一预测因素的一些局限性。
