Department of Anesthesiology, School of Medicine, Teikyo University, Tokyo, Japan.
Ann Thorac Surg. 2011 Sep;92(3):1069-74. doi: 10.1016/j.athoracsur.2011.04.087.
Numerous studies have suggested an inverse relationship between hospital volume and short-term mortality after various major operations. However, the volume-outcome relationship after lung cancer surgery remains controversial. We investigated the effects of hospital volume on various outcomes after lobectomy for lung cancer, including chest tube duration, postoperative length of stay, and in-hospital mortality.
From a total of 5.85 million inpatients in the Japanese Diagnosis Procedure Combination database, we identified 19,831 patients who underwent lobectomy for lung cancer between July and December in 2007 and 2008. Patients were divided into low (≤24 per year), medium-low (25 to 43), medium-high (44 to 67), or high (≥68) hospital-volume groups. Multivariate regression analyses were conducted to analyze the concurrent effects of various factors on postoperative outcomes.
Overall in-hospital mortality was 0.69%, and was significantly lower in the high-volume group compared with the low-volume group (0.48% versus 0.94%; odds ratio 0.60; p=0.047). Chest tube removal occurred earlier in the high-volume group than in the low-volume group (mean 4.0 days versus 5.1; p<0.001). Postoperative length of stay was shorter in the high-volume group than in the low-volume group (mean 11.5 days versus 15.9, p<0.001).
Higher hospital volume was associated with significantly shorter chest tube duration and postoperative length of stay, and lower in-hospital mortality after lobectomy for lung cancer. However, the differences in outcomes between high-volume and low-volume hospitals may be too small to support regionalization of lung cancer operations to high-volume centers.
大量研究表明，在各种主要手术后，医院的手术量与短期死亡率呈反比。然而，肺癌手术后的量效关系仍存在争议。我们调查了医院手术量对肺癌肺叶切除术各种结果的影响，包括胸腔引流管留置时间、术后住院时间和院内死亡率。
我们从日本诊断程序组合数据库中的 585 万住院患者中，确定了 2007 年 7 月至 12 月期间接受肺癌肺叶切除术的 19831 名患者。患者分为低（≤24/年）、中低（25-43）、中高（44-67）或高（≥68）医院量组。进行多变量回归分析以分析各种因素对术后结果的并发影响。
总体院内死亡率为 0.69%，高容量组明显低于低容量组（0.48%比 0.94%；优势比 0.60；p=0.047）。高容量组胸腔引流管拔除时间早于低容量组（平均 4.0 天比 5.1 天；p<0.001）。高容量组的术后住院时间短于低容量组（平均 11.5 天比 15.9 天；p<0.001）。
更高的医院量与明显较短的胸腔引流管时间和术后住院时间以及肺癌肺叶切除术后较低的院内死亡率相关。然而，高容量和低容量医院之间结果的差异可能太小，无法支持将肺癌手术区域化到高容量中心。
