Department of Surgery, McMaster University, Hamilton, ON, Canada,
Ann Surg Oncol. 2013 Nov;20(12):3740-6. doi: 10.1245/s10434-013-3123-2. Epub 2013 Jul 13.
To assess patterns of uptake and outcomes of laparoscopic colon and rectal cancer surgery in Ontario, and the potential influence of surgical fee incentives instituted on October 1, 2005.
We used Ontario administrative databases from fiscal years 2002 to 2009. Study outcomes were uptake rates of laparoscopic surgery, hospital length of stay, 30-day operative mortality, cancer-specific survival, and overall survival. The main descriptor for multivariable regression models was a 5% increase in rate of laparoscopic colon cancer surgery in the previous year.
The annual rate of laparoscopic colon and rectal cancer surgery, respectively, rose from 8.7 to 38.9% and from 4.8 to 19.6%. The greatest increase in rate of laparoscopic colon surgery occurred shortly after October 1, 2005. For each 5% increase in rate of laparoscopic surgery, the odds of 30-day mortality was 1.0 [95% confidence interval (CI) 0.96-1.01, p = 0.264], the hazard of cancer-specific survival was 1.0 (95% CI 0.97-1.00, p = 0.139), the hazard of overall survival was 1.0 (95% CI 0.98-1.00, p = 0.051), and length of hospital stay was lower (estimate = -0.10, 95% CI -0.14 to -0.06, p < 0.001).
In Ontario by the year 2009, 39% of colon and 20% of rectal cancer surgery was provided laparoscopically. Increased rates were associated with a minimal decrease in hospital length of stay and no changes in 30-day mortality, cancer-specific survival, or overall survival. Financial incentives were likely responsible for the marked increase in laparoscopic colon cancer surgery observed after October 1, 2005.
评估安大略省腹腔镜结肠和直肠肿瘤手术的应用模式和结果，以及 2005 年 10 月 1 日实施的手术费用激励措施的潜在影响。
我们使用了安大略省 2002 年至 2009 年的行政数据库。研究结果为腹腔镜手术的采用率、住院时间、30 天手术死亡率、癌症特异性生存率和总体生存率。多变量回归模型的主要描述符是前一年腹腔镜结肠癌手术率增加 5%。
腹腔镜结肠和直肠肿瘤手术的年增长率分别从 8.7%升至 38.9%和从 4.8%升至 19.6%。腹腔镜结肠癌手术率的最大增幅出现在 2005 年 10 月 1 日之后不久。腹腔镜手术率每增加 5%，30 天死亡率的比值比为 1.0（95%置信区间 0.96-1.01，p=0.264），癌症特异性生存率的风险比为 1.0（95%置信区间 0.97-1.00，p=0.139），总体生存率的风险比为 1.0（95%置信区间 0.98-1.00，p=0.051），住院时间更短（估计值为-0.10，95%置信区间为-0.14 至-0.06，p<0.001）。
到 2009 年，安大略省 39%的结肠癌和 20%的直肠癌手术采用了腹腔镜技术。手术率的增加与住院时间的轻微减少相关，而 30 天死亡率、癌症特异性生存率或总体生存率没有变化。2005 年 10 月 1 日之后，腹腔镜结肠癌手术的显著增加可能与经济激励措施有关。
