Nieman Carrie L, Stewart C Matthew, Eisele David W, Pronovost Peter J, Gourin Christine G
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Johns Hopkins Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Laryngoscope. 2018 Jun;128(6):1365-1370. doi: 10.1002/lary.26952. Epub 2017 Oct 17.
OBJECTIVES/HYPOTHESIS: We previously reported that high-volume hospital head and neck cancer (HNCA) surgical care is associated with decreased mortality, largely explained by reduced rates of failure to rescue. Frailty is an independent predictor of mortality, but is significantly less likely in patients receiving high-volume care. We investigate whether differences in frailty rates explain the relationship between volume and outcomes in HNCA patients and whether frailty confounds the relationship between failure to rescue and mortality.
Cross-sectional analysis.
Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 were analyzed using cross-tabulations and multivariate regression. Failure to rescue was defined as death after a major complication. Frailty was defined using frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator.
High-volume hospital care was associated with a lower odds of frailty (odds ratio [OR]: 0.7 [95% confidence interval [CI]: 0.5-1.0]). Frail patients had higher odds of postoperative complications (OR: 4.1 [95% CI: 3.4-4.9]) and mortality (OR: 2.0 [95% CI: 1.3-3.2]), but no difference in failure to rescue rates (OR: 1.0 [95% CI: 0.6-1.6]). High-volume care was not associated with differences in odds of complications (OR: 1.0 [95% CI: 0.8-1.2]), but was associated with significantly decreased odds of mortality (OR: 0.6 [95% CI: 0.5-0.9]) and failure to rescue (OR: 0. 6 [95% CI: 0.3-1.0]), which was not attenuated by adjusting for frailty.
High-volume HNCA surgical care is associated with a significantly lower odds of mortality, which appears to be associated with differences in the response to and management of complications rather than differences in frailty or complication rates.
2c. Laryngoscope, 128:1365-1370, 2018.
目的/假设：我们之前报告过，高容量医院的头颈癌（HNCA）手术治疗与死亡率降低相关，这在很大程度上可归因于抢救失败率的降低。虚弱是死亡率的一个独立预测因素，但在接受高容量治疗的患者中发生的可能性显著较低。我们研究虚弱率的差异是否解释了HNCA患者治疗量与治疗结果之间的关系，以及虚弱是否混淆了抢救失败与死亡率之间的关系。
横断面分析。
使用交叉表和多变量回归分析了2001年至2010年全国住院患者样本中159301例因恶性口腔、喉、下咽或口咽肿瘤接受消融手术患者的出院数据。抢救失败定义为发生重大并发症后的死亡。虚弱使用来自约翰霍普金斯调整临床组虚弱定义诊断指标中的虚弱定义诊断集群来定义。
高容量医院治疗与较低的虚弱几率相关（优势比[OR]：0.7[95%置信区间[CI]：0.5 - 1.0]）。虚弱患者术后并发症（OR：4.1[95%CI：3.4 - 4.9]）和死亡率（OR：2.0[95%CI：1.3 - 3.2]）的几率更高，但抢救失败率无差异（OR：1.0[95%CI：0.6 - 1.6]）。高容量治疗与并发症几率的差异无关（OR：1.0[95%CI：0.8 - 1.2]），但与死亡率（OR：0.6[95%CI：0.5 - 0.9]）和抢救失败率（OR：0.6[95%CI：0.3 - 1.0]）显著降低相关，在对虚弱进行校正后这一关联并未减弱。
高容量HNCA手术治疗与显著较低的死亡几率相关，这似乎与对并发症的反应和管理差异有关，而非与虚弱或并发症发生率差异有关。
2c。《喉镜》，2018年，第128卷，第1365 - 1370页。
