Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Ann Surg Oncol. 2018 Jun;25(6):1580-1587. doi: 10.1245/s10434-018-6339-3. Epub 2018 Jan 18.
Improvement in mortality has been shown for esophagectomies performed at high-volume centers.
This study aimed to determine if centralization of esophageal cancer surgery occurred in the US, and to establish its impact on postoperative mortality. In addition, we aimed to analyze the relationship between regionalization of cancer care and health disparities.
A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2014. Adult patients (≥ 18 years of age) diagnosed with esophageal cancer and who underwent esophagectomy were included. Yearly hospital volume was categorized as low (< 5 procedures), intermediate (5-20 procedures), and high (> 20 procedures). Multivariable analyses on the potential effect of hospital volume on patient outcomes were performed, and the yearly rate of esophagectomies was estimated using Poisson regression.
A total of 5235 patients were included. Esophagectomy at low- [odds ratio (OR) 2.17] and intermediate-volume (OR 1.62) hospitals, compared with high-volume hospitals, was associated with a significant increase in mortality. The percentage of esophagectomies performed at high-volume centers significantly increased during the study period (29.2-68.5%; p < 0.0001). The trend towards high-volume hospitals was different among the different US regions: South (7.7-54.3%), West (15.0-67.6%), Midwest (37.3-67.7%), and Northeast (55.8-86.8%) [p < 0.0001]. Overall, the mortality rate of esophagectomy dropped from 10.0 to 3.5% (p = 0.006), with non-White race, public insurance, and low household income patients also showing a significant reduction in mortality.
A spontaneous centralization for esophageal cancer surgery occurred in the US. This process was associated with a decrease in the mortality rate, without contributing to health disparities.
在高容量中心进行的食管切除术已显示出死亡率的提高。
本研究旨在确定美国是否发生了食管癌手术的集中化，并确定其对术后死亡率的影响。此外，我们旨在分析癌症治疗区域化与健康差距之间的关系。
使用国家住院患者样本进行了 2000-2014 年的回顾性基于人群的分析。纳入诊断为食管癌并接受食管切除术的成年患者（≥18 岁）。每年的医院量分为低（<5 例）、中（5-20 例）和高（>20 例）。对医院量对患者结局的潜在影响进行了多变量分析，并使用泊松回归估计了每年的食管切除术率。
共纳入 5235 例患者。与高容量医院相比，低（比值比 [OR] 2.17）和中（OR 1.62）容量医院的食管切除术与死亡率显著增加相关。在研究期间，高容量中心进行的食管切除术比例显著增加（29.2%-68.5%；p<0.0001）。高容量医院的趋势在不同的美国地区有所不同：南部（7.7%-54.3%）、西部（15.0%-67.6%）、中西部（37.3%-67.7%）和东北部（55.8%-86.8%）[p<0.0001]。总体而言，食管切除术的死亡率从 10.0%降至 3.5%（p=0.006），非白人种族、公共保险和低收入家庭的患者死亡率也显著降低。
美国的食管癌手术自发集中化。这一过程与死亡率的降低有关，而没有导致健康差距的扩大。
