Becker Andreas, Bianchi Marco, Hansen Jens, Tian Zhe, Shariat Shahrokh F, Popa Ioana, Perrotte Paul, Trinh Quoc-Dien, Karakiewicz Pierre I, Sun Maxine
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, QC, H2X 3J4, Canada,
World J Urol. 2014 Dec;32(6):1511-21. doi: 10.1007/s00345-014-1256-y. Epub 2014 Feb 11.
To provide in absolute terms a quantification of regionalization of care from low- to high-volume hospitals in patients treated with nephrectomy for non-metastatic renal cell carcinoma.
Relying on the Nationwide Inpatient Sample, 48,172 patients with non-metastatic renal cell carcinoma undergoing nephrectomy were identified. All analyses focused on five specific endpoints: intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalization, and in-hospital mortality. First, multivariable logistic regression models for prediction of the aforementioned endpoints were fitted among high-volume hospitals treated patients. Second, obtained coefficients from such models were applied onto low-volume hospitals treated individuals. Potentially avoidable events were computed through differences between observed and predicted adverse events. The number needed to treat was generated.
Low-volume hospitals treated individuals were between 11 and 28 % more likely to succumb to an adverse outcome (all P < 0.001). Differences between observed and predicted adverse outcome rates were all in favor of high-volume hospitals, except for in-hospital mortality. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalization, and in-hospital mortality rates were 1.4, 5.6, 7.6, 24.0, and 0.7 %, respectively. Thus, for every 71, 18, 13, 4, and 143 nephrectomies that are redirected to high-volume hospitals, 1 intraoperative complication, postoperative complication, blood transfusion, prolonged hospitalization, and in-hospital mortality could be potentially avoided.
Regionalization from low- to high-volume hospitals for patients undergoing a nephrectomy is associated with important benefits, for both the payer and patient's perspectives.
绝对量化接受肾切除术治疗的非转移性肾细胞癌患者从低容量医院到高容量医院的医疗区域化情况。
依据全国住院患者样本，识别出48172例接受肾切除术的非转移性肾细胞癌患者。所有分析聚焦于五个特定终点：术中并发症、术后并发症、输血、住院时间延长和院内死亡率。首先，在高容量医院治疗的患者中拟合用于预测上述终点的多变量逻辑回归模型。其次，将从此类模型获得的系数应用于低容量医院治疗的个体。通过观察到的和预测的不良事件之间的差异计算潜在可避免事件。计算所需治疗人数。
低容量医院治疗的个体出现不良结局的可能性要高出11%至28%（所有P<0.001）。观察到的和预测的不良结局率之间的差异均有利于高容量医院，但院内死亡率除外。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1.4%、5.6%、7.6%、24.0%和0.7%。因此，每将71例、18例、13例、4例肾切除术和143例肾切除术转诊至高容量医院，可能避免1例术中并发症、术后并发症、输血、住院时间延长和院内死亡。
对于接受肾切除术的患者，从低容量医院到高容量医院的医疗区域化无论从支付方还是患者的角度来看都有重要益处。
