描述高容量癌症切除生态系统在低容量、高质量手术治疗中的作用。

Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care.

作者信息

Kothari Anai N, Blanco Barbara A, Brownlee Sarah A, Evans Ann E, Chang Victor A, Abood Gerard J, Settimi Raffaella, Raicu Daniela S, Kuo Paul C

机构信息

Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.

One:MAP Section of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL.

出版信息

Surgery. 2016 Oct;160(4):839-849. doi: 10.1016/j.surg.2016.07.002. Epub 2016 Aug 11.

DOI:10.1016/j.surg.2016.07.002

PMID:27524432

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5105905/

Abstract

BACKGROUND

Our objective was to determine the hospital resources required for low-volume, high-quality care at high-volume cancer resection centers.

METHODS

Patients who underwent esophageal, pancreatic, and rectal resection for malignancy were identified using Healthcare Cost and Utilization Project State Inpatient Database (Florida and California) between 2007 and 2011. Annual case volume by procedure was used to identify high- and low-volume centers. Hospital data were obtained from the American Hospital Association Annual Survey Database. Procedure risk-adjusted mortality was calculated for each hospital using multilevel, mixed-effects models.

RESULTS

A total of 24,784 patients from 302 hospitals met the inclusion criteria. Of these, 13 hospitals were classified as having a high-volume, oncologic resection ecosystem by being a high-volume hospital for ≥2 studied procedures. A total of 11 of 31 studied hospital factors were strongly associated with hospitals that performed a high volume of cancer resections and were used to develop the High Volume Ecosystem for Oncologic Resections (HIVE-OR) score. At low-volume centers, increasing HIVE-OR score resulted in decreased mortality for rectal cancer resection (P = .038). HIVE-OR was not related to risk-adjusted mortality for esophagectomy (P = .421) or pancreatectomy (P = .413) at low-volume centers.

CONCLUSION

Our study found that in some settings, low-volume, high-quality cancer surgical care can be explained by having a high-volume ecosystem.

摘要

背景

我们的目标是确定高容量癌症切除中心提供低容量、高质量护理所需的医院资源。

方法

利用医疗成本和利用项目州住院数据库（佛罗里达州和加利福尼亚州）识别2007年至2011年间因恶性肿瘤接受食管、胰腺和直肠切除术的患者。按手术计算的年度病例量用于确定高容量和低容量中心。医院数据来自美国医院协会年度调查数据库。使用多级混合效应模型计算每家医院的手术风险调整死亡率。

结果

来自302家医院的24784名患者符合纳入标准。其中，13家医院因≥2项研究手术为高容量医院而被归类为具有高容量肿瘤切除生态系统。在31项研究的医院因素中，共有11项与进行大量癌症切除术的医院密切相关，并被用于制定肿瘤切除高容量生态系统（HIVE-OR）评分。在低容量中心，HIVE-OR评分的增加导致直肠癌切除术死亡率降低（P = .038）。在低容量中心，HIVE-OR与食管切除术（P = .421）或胰腺切除术（P = .413）的风险调整死亡率无关。