Tighe David, Sassoon Isabel, Kwok A, McGurk Mark
Department of Oral and Maxillofacial Surgery, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK.
Dept of Informatics, King's College Hospital, London, UK.
Br J Oral Maxillofac Surg. 2014 Dec;52(10):913-21. doi: 10.1016/j.bjoms.2014.08.020. Epub 2014 Sep 15.
There is a need for a validated means of adjusting for case mix in morbidity audits of patients with cancer of the head and neck. To address this, we did a multicentre audit of 3 U.K. NHS cancer networks that treat patients with head and neck cancer, to compare the incidence of early adverse postoperative outcomes and to develop a means of adjusting for case mix. We did a retrospective and prospective audit of the case notes of 901 consecutive patients who had 1034 operations for squamous cell carcinoma (SCC) of the head and neck under general anaesthesia at 3 NHS hospitals. Analysis of raw data showed postoperative 30-day mortality (n=17) to be consistent between sites (1.7%-1.9%) but 30-day complication rates varied more (34%-49%). Logistic regression models predicting morbidity discriminated well (area under the curve 0.74-0.76). Adjusted morbidity rates for the 3 units were compared on a funnel plot with 95% and 99% confidence intervals to account for random variation. It is possible to benchmark surgical performance by focusing on early postoperative outcomes in head and neck surgery. Morbidity is common and usually has a considerable impact on recovery, bed occupancy, cost, and the patient's perception of the quality of care.
对头颈部癌症患者进行发病率审计时，需要一种经过验证的方法来调整病例组合。为解决这一问题，我们对英国国民健康服务体系（NHS）中3个治疗头颈部癌症患者的癌症网络进行了多中心审计，以比较术后早期不良结局的发生率，并制定一种调整病例组合的方法。我们对3家NHS医院连续901例接受全身麻醉下1034次头颈部鳞状细胞癌（SCC）手术患者的病历进行了回顾性和前瞻性审计。原始数据分析显示，各医院之间术后30天死亡率（n = 17）一致（1.7%-1.9%），但30天并发症发生率差异更大（34%-49%）。预测发病率的逻辑回归模型判别效果良好（曲线下面积为0.74-0.76）。通过漏斗图比较3个单位调整后的发病率，并给出95%和99%置信区间，以考虑随机变异。通过关注头颈部手术的术后早期结局来对标手术表现是可行的。发病率很常见，通常对恢复、床位占用、成本以及患者对护理质量的认知有相当大的影响。
