Minnesota Surgical Outcomes Research Center, Department of Surgery, University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55455, USA.
J Am Coll Surg. 2012 Jan;214(1):81-7. doi: 10.1016/j.jamcollsurg.2011.10.003. Epub 2011 Nov 23.
Previous literature has consistently shown worse operative outcomes at low-volume hospitals (LVH) after complex cancer surgery. Whether patient-related factors impact this association remains unknown. We hypothesize that patient-related factors contribute to receipt of complex cancer surgery at LVH.
Using the 2003-2008 National Inpatient Sample, we identified 59,841 patients who underwent cancer operations for lung, esophagus, and pancreas tumors. Logistic regression models were used to examine the impact of sociodemographic factors on receipt of complex cancer surgery at LVH.
Overall, 38.4% received their cancer surgery at LVH. A higher proportion of esophagectomies were performed at LVH (70.3%), followed by pancreatectomy (38.2%) and lung resection (33.8%). Patients who were non-white, with non-private insurance, and had more comorbidities were all more likely to receive their cancer surgery at LVH (for all, p < 0.05). Multivariate analyses continued to demonstrate that non-white race, insurance status, increased comorbidities, region, and nonelective admission predicted receipt of cancer surgery at LVH across all 3 procedures.
In this large national study, non-white race and increased comorbidities contributed to receipt of cancer surgery at LVH. Patient selection and access to high-volume hospitals are likely reasons worthy of additional investigation. This study provides additional insight into the volume-outcomes relationship. Given the demonstrated outcomes disparity between high-volume hospitals and LVH, future policy and research should encourage mechanisms for referral of patients with cancer to high-volume hospitals for their surgical care.
先前的文献一致表明，在接受复杂癌症手术后，低容量医院（LVH）的手术效果较差。患者相关因素是否会影响这种关联尚不清楚。我们假设患者相关因素会影响在 LVH 进行复杂癌症手术的选择。
利用 2003-2008 年全国住院患者样本，我们确定了 59841 例接受肺癌、食管癌和胰腺癌手术的癌症患者。使用逻辑回归模型来检验社会人口因素对在 LVH 接受复杂癌症手术的影响。
总体而言，38.4%的患者在 LVH 接受了癌症手术。LVH 进行的食管癌切除术比例较高（70.3%），其次是胰切除术（38.2%）和肺切除术（33.8%）。非白人、非私人保险和合并症较多的患者在 LVH 接受癌症手术的比例更高（所有患者，p<0.05）。多变量分析继续表明，非白人种族、保险状况、合并症增多、地区和非择期入院均预测了这 3 种手术在 LVH 中的接受情况。
在这项大型全国性研究中，非白人种族和合并症增多导致了在 LVH 接受癌症手术。患者选择和获得高容量医院可能是值得进一步研究的原因。这项研究为容量-结果关系提供了更多的见解。鉴于高容量医院和 LVH 之间已经存在的结果差异，未来的政策和研究应鼓励将癌症患者转诊至高容量医院接受手术治疗的机制。
