国家对食管癌和胃癌的集中化管理对急诊上消化道疾病的治疗和临床结果的影响。

Influence of national centralization of oesophagogastric cancer on management and clinical outcome from emergency upper gastrointestinal conditions.

机构信息

Department of Surgery and Cancer, Imperial College London, London, UK.

St Mark's Hospital and Academic Institute, Harrow, UK.

出版信息

Br J Surg. 2018 Jan;105(1):113-120. doi: 10.1002/bjs.10640. Epub 2017 Nov 20.

DOI:10.1002/bjs.10640

PMID:29155448

Abstract

BACKGROUND

In England in 2001 oesophagogastric cancer surgery was centralized. The aim of this study was to evaluate whether centralization of oesophagogastric cancer to high-volume centres has had an effect on mortality from different emergency upper gastrointestinal conditions.

METHODS

The Hospital Episode Statistics database was used to identify patients admitted to hospitals in England (1997-2012). The influence of oesophagogastric high-volume cancer centre status (20 or more resections per year) on 30- and 90-day mortality from oesophageal perforation, paraoesophageal hernia and perforated peptic ulcer was analysed.

RESULTS

Over the study interval, 3707, 12 441 and 56 822 patients with oesophageal perforation, paraoesophageal hernia and perforated peptic ulcer respectively were included. There was a passive centralization to high-volume cancer centres for oesophageal perforation (26·9 per cent increase), paraoesophageal hernia (19·5 per cent increase) and perforated peptic ulcer (23·0 per cent increase). Management of oesophageal perforation in high-volume centres was associated with a reduction in 30-day (HR 0·58, 95 per cent c.i. 0·45 to 0·74) and 90-day (HR 0·62, 0·49 to 0·77) mortality. High-volume cancer centre status did not affect mortality from paraoesophageal hernia or perforated peptic ulcer. Annual emergency admission volume thresholds at which mortality improved were observed for oesophageal perforation (5 patients) and paraoesophageal hernia (11). Following centralization, the proportion of patients managed in high-volume cancer centres that reached this volume threshold was 88·0 per cent for oesophageal perforation, but only 30·3 per cent for paraoesophageal hernia.

CONCLUSION

Centralization of low incidence conditions such as oesophageal perforation to high-volume cancer centres provides a greater level of expertise and ultimately reduces mortality.

摘要

背景

2001 年，英国集中开展了胃食管癌症手术。本研究旨在评估胃食管癌症集中于高容量中心是否对不同紧急上消化道疾病的死亡率产生影响。

方法

使用医院入院统计数据库（Hospital Episode Statistics database），识别英格兰（1997-2012 年）入院的患者。分析高容量癌症中心（每年进行 20 次或以上切除术）对食管穿孔、食管旁疝和穿透性消化性溃疡的 30 天和 90 天死亡率的影响。

结果

在研究期间，分别纳入 3707 例、12441 例和 56822 例食管穿孔、食管旁疝和穿透性消化性溃疡患者。食管穿孔（26.9%）、食管旁疝（19.5%）和穿透性消化性溃疡（23.0%）的患者被动集中到高容量癌症中心。高容量癌症中心治疗食管穿孔与 30 天（HR 0.58，95%CI 0.45 至 0.74）和 90 天（HR 0.62，0.49 至 0.77）死亡率降低相关。高容量癌症中心状态对食管旁疝或穿透性消化性溃疡的死亡率没有影响。食管穿孔（5 例）和食管旁疝（11 例）的死亡率改善的年急诊入院量阈值已经观察到。集中化后，达到该容量阈值的高容量癌症中心管理的患者比例，食管穿孔为 88.0%，食管旁疝为 30.3%。