West Middlesex University Hospital, London, UK.
BJU Int. 2014 May;113(5):733-40. doi: 10.1111/bju.12288. Epub 2013 Sep 5.
To quantify in absolute terms the potential benefit of regionalisation of care from low- to high-volume hospitals.
Patients with a primary diagnosis of bladder cancer treated with radical cystectomy (RC) were identified within the Nationwide Inpatient Sample, a retrospective observational population-based cohort of the USA, between 1998 and 2009. Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality rates represented the outcomes of interest. Potentially avoidable outcomes were calculated by subtracting predicted rates (i.e. estimated outcomes if care was delivered at a high-volume hospital) from observed rates (i.e. actual observed outcomes after care delivered at a low-volume hospital). Multivariable logistic regression models and number needed to treat were generated.
Patients treated at high-volume hospitals had lower odds of complications during hospitalisation than those treated in low-volume hospitals. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalisation, and in-hospital mortality rates were 0.6, 7.4, 2.8, 9.4, and 2.0%, respectively. This corresponds to a number needed to redirect from low- to high-volume hospitals in order to avoid one adverse event of 166, 14, 36, 11 and 50, respectively.
This is the first report to quantify the potential benefit of regionalisation of RC for muscle-invasive bladder cancer to high-volume hospitals.
从低容量医院到高容量医院，对护理区域化的潜在获益进行绝对数量的量化。
在 1998 年至 2009 年间，在美国全国住院患者样本中，通过回顾性观察性基于人群的队列，确定了接受根治性膀胱切除术（RC）治疗的原发性膀胱癌患者。术中及术后并发症、输血、住院时间延长和院内死亡率是感兴趣的结果。潜在可避免的结果通过从观察到的比率（即在低容量医院接受治疗后的实际观察结果）中减去预测的比率（即如果在高容量医院提供护理，则估计的结果）来计算。生成了多变量逻辑回归模型和需要治疗的数量。
与在低容量医院接受治疗的患者相比，在高容量医院接受治疗的患者在住院期间发生并发症的可能性较小。潜在可避免的术中并发症、术后并发症、输血、住院时间延长和院内死亡率分别为 0.6%、7.4%、2.8%、9.4%和 2.0%。这相当于需要重新定向从低容量医院到高容量医院以避免 166 个不良事件中的一个、14 个、36 个、11 个和 50 个。
这是第一个报告对将肌层浸润性膀胱癌的 RC 区域化到高容量医院的潜在获益进行量化的报告。
