Yu Hua-Yin, Hevelone Nathanael D, Patel Sunil, Lipsitz Stuart R, Hu Jim C
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 1153 Centre Street, Suite 4420, Boston, MA 02130, USA.
Adv Urol. 2012;2012:189823. doi: 10.1155/2012/189823. Epub 2012 Apr 9.
Objectives. Retroperitoneal lymph node dissection (RPLND) outcomes for testis cancer originate mostly from single-center series. We characterized population-based utilization, costs, and outcomes and assessed whether higher volume affects outcomes. Methods and Materials. Using the US Nationwide Inpatient Sample from 2001-2008, we identified 993 RPLND and used propensity score methods to assess utilization, costs, and inpatient outcomes based on hospital surgical volume. Results. 51.6% of RPLND were performed at hospitals where there were two or fewer cases per year. RPLND was more commonly performed at large urban teaching hospitals, where men were younger, more likely to be white and earning incomes exceeding the 50th percentile (all P ≤ .05). Higher hospital volumes were associated with fewer complications and more routine home discharges (all P ≤ .047). However, higher volume hospitals had more transfusions (P = .004) and incurred $1,435 more in median costs (P < .001). Limitations include inability to adjust for tumor characteristics and absence of outpatient outcomes. Conclusions. Sociodemographic differences exist between high versus low volume RPLND hospitals. Although higher volume hospitals had more transfusions and higher costs, perhaps due to more complex cases, they experienced fewer complications. However, most RPLND are performed at hospitals where there were two or fewer cases per year.
目的。睾丸癌的腹膜后淋巴结清扫术（RPLND）结果大多来自单中心系列研究。我们描述了基于人群的手术应用情况、成本和结果，并评估了手术量较高是否会影响结果。方法和材料。利用2001 - 2008年美国全国住院患者样本，我们识别出993例RPLND手术，并使用倾向评分方法根据医院手术量评估手术应用情况、成本和住院结果。结果。51.6%的RPLND手术是在每年病例数为2例或更少的医院进行的。RPLND手术在大型城市教学医院更常进行，这些医院的男性患者更年轻，更可能是白人，收入超过第50百分位数（所有P≤0.05）。医院手术量较高与并发症较少和更多常规出院回家相关（所有P≤0.047）。然而，手术量较高的医院输血更多（P = 0.004），中位成本高出1435美元（P < 0.001）。局限性包括无法调整肿瘤特征以及缺乏门诊结果。结论。RPLND手术量高的医院和低的医院之间存在社会人口统计学差异。尽管手术量较高的医院输血更多且成本更高，这可能是由于病例更复杂，但它们的并发症较少。然而，大多数RPLND手术是在每年病例数为2例或更少的医院进行的。
