Department of Surgery, K-6, Leiden University Medical Center, Leiden, The Netherlands.
Ann Surg Oncol. 2013 Oct;20(11):3370-6. doi: 10.1245/s10434-013-3037-z. Epub 2013 Jun 4.
This study was designed to evaluate the association between structural hospital characteristics and failure-to-rescue (FTR) after colorectal cancer surgery. A growing body of evidence suggests a large hospital variation concerning mortality rates in patients with a severe complication (FTR) in colorectal cancer surgery. Which structural hospital factors are associated with better FTR rates remains largely unclear.
All patients undergoing colorectal cancer surgery from 2009 through 2011 in 92 Dutch hospitals were analysed. Univariate and multivariate logistic regression models, including casemix, hospital volume, teaching status, and different levels of intensive care unit (ICU) facilities, were used to analyse risk-adjusted FTR rates.
A total of 25,591 patients from 92 hospitals were included. The FTR rate ranged between 0 and 39 %. In univariate analysis, high hospital volume (>200 vs. ≤200 patients/year), teaching status (academic vs. teaching vs. nonteaching hospitals) and high level of ICU facilities (highest level 3 vs. lowest level 1) were associated with lower FTR rates. Only the higher levels of ICU facilities (2 or 3 compared with level 1) were independently associated with lower failure-to-rescue rates (odds ratio 0.72; 95 % confidence interval 0.65-0.88) in multivariate analysis.
Hospital type and annual hospital volume were not independently associated with FTR rates in colorectal cancer surgery. Instead, the lowest level of ICU facilities was independently associated with higher rates. This suggests that a more advanced ICU may be an important factor that contributes to better failure-to-rescue rates, although individual hospitals perform well with lower ICU levels.
本研究旨在评估结直肠癌手术后结构性医院特征与救治失败（FTR）之间的关系。越来越多的证据表明，在结直肠癌手术后严重并发症（FTR）患者的死亡率方面，医院之间存在较大差异。哪些结构性医院因素与更好的 FTR 率相关仍很大程度上不清楚。
分析了 2009 年至 2011 年期间 92 家荷兰医院接受结直肠癌手术的所有患者。使用单变量和多变量逻辑回归模型，包括病例组合、医院容量、教学地位以及不同级别的重症监护病房（ICU）设施，分析风险调整后的 FTR 率。
共纳入 92 家医院的 25591 例患者。FTR 率在 0 至 39%之间。单因素分析显示，高医院容量（>200 例/年与≤200 例/年）、教学地位（学术与教学与非教学医院）和 ICU 设施水平高（最高水平 3 与最低水平 1）与较低的 FTR 率相关。仅 ICU 设施的较高水平（2 级或 3 级与 1 级相比）与多变量分析中较低的救治失败率独立相关（比值比 0.72；95%置信区间 0.65-0.88）。
医院类型和医院年容量与结直肠癌手术后的 FTR 率无关。相反，ICU 设施的最低水平与更高的 FTR 率独立相关。这表明更先进的 ICU 可能是导致救治失败率降低的一个重要因素，尽管一些医院在较低的 ICU 水平下表现良好。
