Spencer Ryan J, Hacker Kari E, Griggs Jennifer J, Rice Laurel W, Reynolds R Kevin, Uppal Shitanshu
Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin; and the Departments of Obstetrics and Gynecology and Hematology and Oncology and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Obstet Gynecol. 2017 Aug;130(2):305-314. doi: 10.1097/AOG.0000000000002140.
To evaluate the utility of using 90-day as an adjunct to 30-day mortality rates after surgical cytoreduction for serous ovarian cancer and to compare them across hospitals of differing case volumes over time.
We performed a retrospective cohort study using the National Cancer Database of women undergoing cytoreductive surgery for high-grade serous carcinoma between 2004 and 2012. The primary outcome of the study was mortality rate by hospital volume. The secondary outcome was to evaluate the performance of hospital rankings based on 30- and 90-day mortality rates. Hospitals were categorized by cases per year as low volume (10 or fewer), intermediate (11-20), high (21-30), and ultra-high (31 or more).
A total of 24,827 women from 602 hospitals were included. Overall 30-day mortality was 2.1% (95% CI 1.95-2.3) compared with 90-day mortality of 5.1% (95% CI 4.8-5.4%, P<.001). For each hospital volume category, the 90-day mortality was approximately double that of the 30-day mortality. Substituting 90-day in place of 30-day mortality for hospital ranking, 57 hospitals (9.5%) changed ranks (26 worsened and 31 improved). Based on the logistic regression model (after controlling for age, race-ethnicity, income, Charlson comorbidity index, insurance status, hospital volume, distance from place of residence to the hospital, receipt of neoadjuvant chemotherapy, and year of diagnosis), care at the ultra-high-volume centers was an independent predictor of lower odds of death at 90 days [adjusted odds ratios (OR) 0.60, 95% CI 0.38-0.96, P=.034] but not at 30 days (adjusted OR 0.64, 95% CI 0.35-1.18).
Compared with low-volume centers, ultra-high-volume centers are associated with significantly lower 30- and 90-day risk-adjusted mortality. The 90-day mortality rate is double that of the 30-day rate and may be a better metric for assessing the initial quality of care for patients with ovarian cancer.
评估将90天死亡率作为浆液性卵巢癌肿瘤细胞减灭术后30天死亡率的辅助指标的效用，并比较不同时间段内病例数量不同的医院之间的这两个指标。
我们利用国家癌症数据库进行了一项回顾性队列研究，研究对象为2004年至2012年间接受高级别浆液性癌肿瘤细胞减灭术的女性。该研究的主要结局是按医院病例数量划分的死亡率。次要结局是评估基于30天和90天死亡率的医院排名表现。医院按每年病例数分为低病例量（10例或更少）、中等病例量（11 - 20例）、高病例量（21 - 30例）和超高病例量（31例或更多）。
共纳入了来自602家医院的24,827名女性。总体30天死亡率为2.1%（95%置信区间1.95 - 2.3），而90天死亡率为5.1%（95%置信区间4.8 - 5.4%，P <.001）。对于每个医院病例量类别，90天死亡率约为30天死亡率的两倍。用90天死亡率替代30天死亡率进行医院排名时，57家医院（9.5%）的排名发生了变化（26家变差，31家变好）。基于逻辑回归模型（在控制了年龄、种族 - 民族、收入、查尔森合并症指数、保险状况、医院病例量、居住地到医院的距离、新辅助化疗的接受情况以及诊断年份后），超高病例量中心的护理是90天时较低死亡几率的独立预测因素[调整后的优势比（OR）为0.60，95%置信区间0.38 - 0.96，P = 0.034]，但在30天时不是（调整后的OR为0.64，95%置信区间0.35 - 1.18）。
与低病例量中心相比，超高病例量中心与30天和90天风险调整后的死亡率显著降低相关。90天死亡率是30天死亡率的两倍，可能是评估卵巢癌患者初始护理质量的更好指标。
