昆士兰复杂上消化道癌手术后与死亡率改善相关的医院特征评估。

Assessment of hospital characteristics associated with improved mortality following complex upper gastrointestinal cancer surgery in Queensland.

作者信息

Narendra Aaditya, Baade Peter D, Aitken Joanne F, Fawcett Jonathan, Smithers Bernard M

机构信息

Upper-GI, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.

Cancer Council Queensland, Brisbane, Queensland, Australia.

出版信息

ANZ J Surg. 2019 Nov;89(11):1404-1409. doi: 10.1111/ans.15389. Epub 2019 Sep 3.

DOI:10.1111/ans.15389

PMID:31480100

Abstract

BACKGROUND

High hospital-volume and service capability are associated with improved mortality following complex cancer surgery. Using a population-based study in Queensland, we assessed differences in mortality following oesophagectomy and pancreaticoduodenectomy, comparing high- and low-volume hospitals stratified by service capability.

METHODS

Data on all patients undergoing oesophagectomy and pancreaticoduodenectomy for cancer in Queensland between 2001 and 2015 were obtained from the Queensland Oncology Repository. Hospital service capability was defined using the 2015 Australian Institute of Health and Welfare hospital peer groupings. Hospitals were grouped into 'high-volume (≥6 oesophagectomies or pancreaticoduodenectomies annually) with high service capability'; 'low-volume (<6) with high service capability' and 'low-volume with low service capability'. Multivariate Poisson models were used to estimate differences in 30- and 90-day mortality between hospital groups adjusting for age, sex, socioeconomic status, Charlson and American Society of Anesthesiologists scores, chemotherapy, radiotherapy, stage and time-period.

RESULTS

For oesophagectomy, adjusted 90-day mortality was higher in low-volume compared with high-volume hospitals, regardless of service capability (low-volume, high service: incident rate ratio (IRR) 3.86, 95% confidence interval (CI) 1.74-8.57; low-volume, low service: IRR 3.40, 95% CI 1.16-10.00). For pancreaticoduodenectomy, mortality was higher in low-volume compared with high-volume centres regardless of service capability: 30-day mortality (low-volume, high service: IRR 2.32, 95% CI 1.07-5.03; low-volume, low service: IRR 3.92, 95% CI 1.45-10.61); 90-day mortality (low-volume, high service: IRR 2.36, 95% CI 1.29-4.30; low-volume, low service: IRR 3.32, 95% CI 1.64-6.71).

CONCLUSION

High hospital resection volumes are associated with lower post-operative mortality following oesophagectomy and pancreaticoduodenectomy regardless of hospital service capability. This data supports centralization of these procedures to high-volume centres.

摘要

背景

医院的高手术量和服务能力与复杂癌症手术后死亡率的改善相关。通过在昆士兰州进行的一项基于人群的研究，我们评估了食管癌切除术和胰十二指肠切除术后的死亡率差异，比较了按服务能力分层的高手术量和低手术量医院。

方法

从昆士兰肿瘤库获取了2001年至2015年间昆士兰州所有因癌症接受食管癌切除术和胰十二指肠切除术患者的数据。医院服务能力采用2015年澳大利亚卫生与福利研究所的医院同行分组来定义。医院被分为“高手术量（每年≥6例食管癌切除术或胰十二指肠切除术）且服务能力高”；“低手术量（<6例）且服务能力高”以及“低手术量且服务能力低”。多变量泊松模型用于估计医院组之间30天和90天死亡率的差异，并对年龄、性别、社会经济地位、查尔森评分和美国麻醉医师协会评分、化疗、放疗、分期和时间段进行了调整。

结果

对于食管癌切除术，无论服务能力如何，低手术量医院的调整后90天死亡率均高于高手术量医院（低手术量、服务能力高：发生率比（IRR）3.86，95%置信区间（CI）1.74 - 8.57；低手术量、服务能力低：IRR 3.40，95% CI 1.16 - 10.00）。对于胰十二指肠切除术，无论服务能力如何，低手术量中心的死亡率均高于高手术量中心：30天死亡率（低手术量、服务能力高：IRR 2.32，95% CI 1.07 - 5.03；低手术量、服务能力低：IRR 3.92，95% CI 1.45 - 10.61）；90天死亡率（低手术量、服务能力高：IRR 2.36，95% CI 1.29 - 4.30；低手术量、服务能力低：IRR 3.32，95% CI 1.64 - 6.71）。