Cancer Epidemiology and Services Research, Sydney School of Public Health, Sydney Medical School, University of Sydney.
Br J Surg. 2013 Nov;100(12):1655-63. doi: 10.1002/bjs.9293.
Rates of abdominoperineal resection (APR) have been suggested as a solitary surrogate marker for comparing overall hospital quality in rectal cancer surgery. This study investigated the value of this marker by examining the associations between hospital APR rates and other quality indicators.
Hospital-level correlations between risk-adjusted APR rates for low rectal cancer and six risk-adjusted outcomes and six care processes were performed (such as 30-day mortality, complications, timely treatment). The ability of APR rates to discriminate between hospitals' performance was examined by means of hospital variance results in multilevel regression models and funnel plots.
A linked population-based data set identified 1703 patients diagnosed in 2007 and 2008 who underwent surgery for rectal cancer. Some 15.9 (95 per cent confidence interval (c.i.) 14.2 to 17.6) per cent of these patients had an APR. Among 707 people with low rectal cancer, 38.2 (34.6 to 41.8) per cent underwent APR. Although risk-adjusted hospital rates of APR for low rectal cancer varied by up to 100 per cent, only one hospital (1 per cent) fell outside funnel plot limits and hospital variance in multilevel models was not very large. Lower hospital rates of APR for low rectal cancer did not correlate significantly with better hospital-level outcomes or process measures, except for recording of pathological stage (r = -0.55, P = 0.019). Patients were significantly more likely to undergo APR for low rectal cancer if they attended a non-tertiary metropolitan hospital (adjusted odds ratio 2.14, 95 per cent c.i. 1.11 to 4.15).
APR rates do not appear to be a useful surrogate marker of overall hospital performance in rectal cancer surgery.
腹会阴切除术（APR）的比率被认为是比较直肠癌手术整体医院质量的单一替代指标。本研究通过检查医院 APR 率与其他质量指标之间的关联，研究了该指标的价值。
对低直肠癌的风险调整 APR 率与六个风险调整结果和六个护理过程之间的医院水平相关性进行了分析（如 30 天死亡率、并发症、及时治疗）。通过多水平回归模型和漏斗图检查 APR 率区分医院绩效的能力。
一个基于人群的链接数据集确定了 2007 年和 2008 年接受直肠癌手术的 1703 名患者。这些患者中有 15.9%（95%置信区间（CI）14.2%至 17.6%）接受了 APR。在 707 名低位直肠癌患者中，38.2%（34.6%至 41.8%）接受了 APR。尽管低位直肠癌的风险调整后医院 APR 率差异高达 100%，但只有一家医院（1%）超出了漏斗图的限制，多水平模型中的医院方差也不是很大。低位直肠癌的医院 APR 率较低与医院水平的结局或过程测量指标没有显著相关性，除了病理分期的记录（r=-0.55，P=0.019）。如果患者在非三级大都市医院就诊，他们接受低位直肠癌 APR 的可能性显著增加（调整后的优势比 2.14，95%置信区间 1.11 至 4.15）。
APR 率似乎不是直肠癌手术整体医院绩效的有用替代指标。
