Division of Gynecologic Oncology, the Institute for Healthcare Policy and Innovation, the Department of Medicine, Division of Hematology Oncology, and the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan; the Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin.
Obstet Gynecol. 2018 Jul;132(1):126-136. doi: 10.1097/AOG.0000000000002693.
To evaluate the role of 30-day readmission rate as a quality of care metric in patients undergoing ovarian cancer surgery.
We performed a retrospective cohort study of women diagnosed between 2004 and 2013 with advanced-stage, high-grade, serous carcinoma who underwent primary treatment. Using the National Cancer Database, we compared the performance of hospital risk-adjusted 30-day readmission rate to other quality of care metrics (risk-adjusted 30- and 90-day mortality, rates of adherence to guideline-based care, and overall survival) within hospitals categorized by yearly case volume (10 or less, 11-20, 21-30, and 31 cases per year or more).
A total of 42,931 patients met the inclusion criteria. The overall unplanned 30-day readmission rate was 6.36% (95% CI 6.13-6.59). After adjusting for comorbidity, stage, histology, and sociodemographic and treatment factors, hospitals performing 31 cases per year or more had a 24% higher likelihood of readmission (adjusted odds ratio [OR] 1.25, 95% CI 1.06-1.46) when compared with those performing 10 cases per year or less. However, hospitals performing 31 cases per year or more had a significantly lower risk-adjusted 90-day mortality (adjusted OR 0.74, 95% CI 0.60-0.91) despite higher rates of complex surgical procedures and higher rates of guideline-concordant care delivery (86% vs 77%, P<.001). In the Cox proportional hazards regression model, care at a high-volume hospital was independently predictive of lower hazard of death (adjusted hazard ratio 0.86, 95% CI 0.82-0.90).
Hospitals with 31 cases per year or more have a lower 30- and 90-day mortality despite performing more complex surgeries, are more likely to be adherent to guideline-based care, and achieved higher overall survival.
评估 30 天再入院率作为卵巢癌手术患者护理质量指标的作用。
我们对 2004 年至 2013 年间诊断为高级别浆液性高级别卵巢癌并接受初次治疗的女性进行了回顾性队列研究。我们利用国家癌症数据库，比较了医院风险调整后 30 天再入院率与其他护理质量指标（风险调整后 30 天和 90 天死亡率、基于指南的护理依从率和总生存率）在按每年病例数分类的医院（每年 10 例或更少、11-20 例、21-30 例和 31 例或更多）中的表现。
共有 42931 名患者符合纳入标准。总计划外 30 天再入院率为 6.36%（95%CI 6.13-6.59）。在调整了合并症、分期、组织学以及社会人口学和治疗因素后，与每年 10 例或更少的医院相比，每年进行 31 例或更多手术的医院再入院的可能性高 24%（调整后的优势比[OR]1.25，95%CI 1.06-1.46）。然而，尽管每年进行 31 例手术的医院进行了更复杂的手术程序，并且提供了更高比例的符合指南的护理服务（86%比 77%，P<.001），但其风险调整后的 90 天死亡率却明显较低（调整后的 OR 0.74，95%CI 0.60-0.91）。在 Cox 比例风险回归模型中，高容量医院的护理独立预测死亡率降低（调整后的危险比 0.86，95%CI 0.82-0.90）。
尽管每年进行 31 例手术的医院进行了更复杂的手术，但仍具有较低的 30 天和 90 天死亡率，更可能遵循基于指南的护理，并且实现了更高的总体生存率。
