Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
J Gastrointest Surg. 2019 Jul;23(7):1425-1434. doi: 10.1007/s11605-019-04233-w. Epub 2019 May 8.
Data on the impact of hospital volume and travel distance on patient outcomes after major abdominal surgery remain poorly defined. We sought to characterize the relationship of travel distance, hospital volume, and long-term outcomes of patients undergoing surgical resection of hepatocellular carcinoma (HCC).
The 2004-2015 National Cancer Database was used to identify patients who underwent resection of HCC. Patients were stratified according to travel distance and hospital volume quartiles, and multivariable regression models were utilized to examine the impact of travel distance, hospital volume, and travel distance/hospital volume on overall survival (OS).
Among the 12,266 patients identified, procedures included wedge/segmental resections (N = 7354, 59.9%), hemi-hepatectomy (N = 4003, 32.6%), and extended hepatectomy (N = 909, 7.5%). Stratifying data into quartiles, travel distance to surgical care was ≤ 5.7 miles (mi), > 5.7-14.2 mi, > 14.2-44.4 mi, and ≥ 44.4 mi, while hospital volume quartiles determined on the hospital level were ≤ 1 case per year, 1.1-4, 4.1-12.5, and ≥ 12.5. On multivariable analysis, increased hospital volume was associated with decreased hazard of mortality (HR 0.69, 95% CI 0.45-0.82, p < 0.001). Travel distance was not significantly associated with hazard of mortality. Furthermore, only hospital volume was associated with mortality (HR 0.67, 95% CI 0.56-0.80, p < 0.001) after controlling for both travel distance and hospital volume.
Only hospital volume was associated with increased hazard of mortality. The benefits of undergoing resection for HCC at a high-volume hospital appear to outweigh the inconvenience of longer travel distances.
关于医院容量和患者接受大腹部手术后的旅行距离对患者结局的影响的数据仍然定义不佳。我们试图描述旅行距离、医院容量与接受肝细胞癌（HCC）手术切除患者的长期结局之间的关系。
利用 2004 年至 2015 年国家癌症数据库，识别接受 HCC 切除术的患者。患者根据旅行距离和医院容量四分位数进行分层，并使用多变量回归模型来检查旅行距离、医院容量以及旅行距离/医院容量对总生存率（OS）的影响。
在确定的 12266 例患者中，手术方式包括楔形/节段切除术（N=7354，59.9%）、半肝切除术（N=4003，32.6%）和扩大肝切除术（N=909，7.5%）。将数据分层为四分位数，手术治疗的旅行距离分别为≤5.7 英里（mi）、>5.7-14.2 mi、>14.2-44.4 mi 和≥44.4 mi，而医院容量四分位数则根据医院水平确定为每年≤1 例、1.1-4 例、4.1-12.5 例和≥12.5 例。多变量分析显示，医院容量增加与死亡风险降低相关（HR 0.69，95%CI 0.45-0.82，p<0.001）。旅行距离与死亡风险无显著相关性。此外，仅在控制了旅行距离和医院容量后，医院容量才与死亡率相关（HR 0.67，95%CI 0.56-0.80，p<0.001）。
只有医院容量与死亡风险增加相关。在高容量医院接受 HCC 切除术的好处似乎超过了旅行距离较长带来的不便。
