Falcoz Pierre-Emmanuel, Puyraveau Marc, Rivera Caroline, Bernard Alain, Massard Gilbert, Mauny Frederic, Dahan Marcel, Thomas Pascal-Alexandre
Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
Clinical Methodology Center, Besançon University Hospital, Besançon, France.
J Thorac Cardiovasc Surg. 2014 Sep;148(3):841-8; discussion 848. doi: 10.1016/j.jtcvs.2014.01.030. Epub 2014 Jan 25.
Our objective was to analyze the time trend variation of 30-day mortality after lung cancer surgery, and to quantify the impact of surgeon and hospital volumes over a 5-year period in France.
We used Epithor, the French national thoracic database and benchmark tool, which catalogues more than 180,000 procedures of 89 private and public hospitals in France. From January 2005 to December 2010, 19,556 patients who underwent major lung resection (lobectomy, bilobectomy, pneumonectomy) were included in our study. Multilevel logistic models were designed to investigate the relationship between 30-day mortality and surgeon (model 1) or hospital (model 2) volumes. The 3 levels considered were the patient, the surgeon, and the hospital.
From 2005 to 2007, the 30-day mortality of patients who underwent major lung resection averaged 10%, and then decreased until it reached 3.8% in 2010 (P < .0001). A significant decrease in 30-day mortality was observed over time (P = .0046). During the study period, the mean annual number of procedures per surgeon was 46.1 (standard deviation [SD] = 23.6) and per hospital was 97.9 (SD = 50.8). Model 1 showed that surgeon volume had a significant impact on 30-day mortality (P = .03), whereas model 2 failed to show that hospital volume influenced 30-day mortality (P = .75).
Since 2007, when France's first National Cancer Plan became effective, 30-day mortality of primary lung cancer surgery has decreased and currently measures 3.8%. Low mortality was correlated with higher surgeon volume but was not influenced by hospital volume, which cannot be considered a proxy measure for determining the safety of lung cancer surgery.
我们的目的是分析肺癌手术后30天死亡率的时间趋势变化，并量化法国5年期间外科医生手术量和医院手术量的影响。
我们使用了法国国家胸部数据库及基准工具Epithor，该数据库收录了法国89家私立和公立医院的超过180,000例手术。2005年1月至2010年12月，19,556例行主要肺切除术（肺叶切除术、双肺叶切除术、全肺切除术）的患者纳入我们的研究。设计多水平逻辑模型以研究30天死亡率与外科医生（模型1）或医院（模型2）手术量之间的关系。所考虑的3个水平为患者、外科医生和医院。
2005年至2007年，行主要肺切除术患者的30天死亡率平均为10%，之后下降，到2010年降至3.8%（P <.0001）。随着时间推移，观察到30天死亡率显著下降（P =.0046）。研究期间，每位外科医生每年的平均手术例数为46.1（标准差[SD]=23.6），每家医院每年的平均手术例数为97.9（SD = 50.8）。模型1显示外科医生手术量对30天死亡率有显著影响（P =.03），而模型2未显示医院手术量影响30天死亡率（P =.75）。
自2007年法国首个国家癌症计划生效以来，原发性肺癌手术的30天死亡率有所下降，目前为3.8%。低死亡率与较高的外科医生手术量相关，但不受医院手术量影响，因此不能将医院手术量视为确定肺癌手术安全性的替代指标。
