Northern Clinical School, University of Sydney, Sydney, NSW, Australia.
Cancer Institute NSW, Sydney, NSW, Australia.
Med J Aust. 2014 Apr 21;200(7):408-13. doi: 10.5694/mja13.11182.
To examine the relationship between hospital volume and patient outcomes for New South Wales hospitals performing oesophagectomy and gastrectomy for oesophagogastric cancer.
DESIGN, SETTING AND PATIENTS: A retrospective, population-based cohort study of NSW residents diagnosed with a new case of invasive oesophageal or gastric cancer who underwent oesophagectomy or gastrectomy between 2001 and 2008 in NSW hospitals using linked de-identified data from the NSW Central Cancer Registry, the National Death Index and the NSW Admitted Patient Data Collection. A higher-volume hospital was defined as one performing > 6 relevant procedures per year.
Odds ratios for > 21-day length of stay, 28-day unplanned readmission, 30-day mortality and 90-day mortality, and hazard ratios (HRs) for 5-year absolute and conditional survival.
Oesophagectomy (908 patients) and gastrectomy (1621 patients) were undertaken in 42 and 84 hospitals, respectively, between 2001 and 2008. Median annual hospital volume ranged from 2 to 4 for oesophagectomies and ranged from 2 to 3 for gastrectomies. Controlling for known confounders, no associations between hospital volume and > 21-day length of stay and 28-day unplanned readmission were found. Overall 30-day mortality was 4.1% and 4.4% for oesophagectomy and gastrectomy, respectively. Five-year absolute survival was significantly better for patients who underwent oesophagectomy in higher-volume hospitals (adjusted HR for lower-volume hospitals, 1.28 [95% CI, 1.10-1.49]; P = 0.002) and for those with localised gastric cancer who underwent gastrectomy in higher-volume hospitals (adjusted HR for lower-volume hospitals, 1.83 [95% CI, 1.28-2.61]; P = 0.001).
These data support initial surgery for oesophagogastric cancer in higher-volume hospitals.
研究新南威尔士州（NSW）施行食管癌和胃癌切除术的医院的容量与患者结局之间的关系。
设计、地点和患者：这是一项基于人群的 NSW 居民回顾性队列研究，纳入 2001 年至 2008 年期间在 NSW 医院接受食管癌或胃癌切除术的患者，使用 NSW 中央癌症登记处、国家死亡索引和 NSW 入院患者数据采集处的去标识化数据进行链接。高容量医院定义为每年施行>6 例相关手术的医院。
21 天以上住院时间、28 天非计划性再入院、30 天死亡率和 90 天死亡率的比值比（ORs），以及 5 年绝对和条件生存率的风险比（HRs）。
2001 年至 2008 年间，42 家医院施行食管癌切除术（908 例患者），84 家医院施行胃癌切除术（1621 例患者）。每年医院的中位数手术量范围为 2 至 4 例食管癌切除术，2 至 3 例胃癌切除术。在控制已知混杂因素后，未发现医院容量与 21 天以上住院时间和 28 天非计划性再入院之间存在关联。食管癌和胃癌切除术的 30 天总死亡率分别为 4.1%和 4.4%。在高容量医院接受手术的患者，5 年绝对生存率显著提高（低容量医院的校正 HR，1.28 [95%CI，1.10-1.49]；P = 0.002），且在高容量医院接受局部胃癌切除术的患者，5 年绝对生存率也显著提高（低容量医院的校正 HR，1.83 [95%CI，1.28-2.61]；P = 0.001）。
这些数据支持在高容量医院进行食管癌和胃癌的初始手术。
