Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Health Services Management and Policy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Ann Surg Oncol. 2020 Jun;27(6):1889-1897. doi: 10.1245/s10434-020-08279-y. Epub 2020 Feb 27.
The aim of the current study is to assess rates of textbook outcome (TO) among Medicare beneficiaries undergoing hepatopancreatic (HP) surgery for cancer at dedicated cancer centers (DCCs) and National Cancer Institute affiliated cancer centers (NCI-CCs) versus non-DCC non-NCI hospitals.
Medicare Inpatient Standard Analytic Files were utilized to identify patients undergoing HP surgery between 2013 and 2017. TO was defined as no postoperative surgical complications, no 90-day mortality, no prolonged length of hospital stay, and no 90-day readmission after discharge.
Among 21,234 Medicare patients, 8.2% patients underwent surgery at DCCs whereas 32.1% underwent surgery at NCI-CCs and 59.7% underwent an operation at neither DCCs nor NCI-CCs. Although DCCs more often cared for patients with severe comorbidities [Charlson score > 5: DCCs, 1195 (68.9%), NCI-CCs, 3687 (54.1%), others, 3970 (31.3%); p < 0.001], DCCs achieved higher rates of TO compared with NCI-CCs and other US hospitals. Interestingly, DCCs were more likely to perform surgery with a minimally invasive approach versus NCI-CCs and other US hospitals (17.0%, n = 295, vs. 12.6%, n = 856 vs. 11.9%, n = 1504, p < 0.001). On multivariable analysis, patients undergoing liver surgery at DCCs had 31% and 36% higher odds of achieving TO compared with NCI-CCs and other US hospitals, respectively. Medicare expenditure was substantially lower for patients achieving TO at DCCs compared with patients who achieved a TO at NCI-CCs.
Even though DCCs more frequently took care of patients with high comorbidity burden, the likelihood of achieving TO for HP surgery at DCCs was higher compared with NCI-CCs and other US hospitals. The data suggest that DCCs provide higher-value surgical care for patients with HP malignancies.
本研究旨在评估在专门癌症中心（DCC）和美国国立癌症研究所附属癌症中心（NCI-CC）接受肝癌胰腺（HP）手术的医疗保险受益人的教科书结局（TO）率，与非 DCC 非 NCI 医院相比。
利用医疗保险住院标准分析文件，确定 2013 年至 2017 年间接受 HP 手术的患者。TO 定义为无术后手术并发症、90 天内无死亡、无延长住院时间和出院后 90 天内无再入院。
在 21234 名医疗保险患者中，8.2%的患者在 DCC 接受手术，32.1%的患者在 NCI-CC 接受手术，59.7%的患者在 DCC 和 NCI-CC 均未接受手术。尽管 DCC 更常照顾患有严重合并症的患者[Charlson 评分>5：DCC，1195（68.9%），NCI-CC，3687（54.1%），其他，3970（31.3%）；p<0.001]，但与 NCI-CC 和其他美国医院相比，DCC 达到 TO 的比例更高。有趣的是，与 NCI-CC 和其他美国医院相比，DCC 更倾向于采用微创方法进行手术（17.0%，n=295，vs.12.6%，n=856 vs.11.9%，n=1504，p<0.001）。多变量分析显示，与 NCI-CC 和其他美国医院相比，在 DCC 接受肝切除术的患者达到 TO 的几率分别高 31%和 36%。与在 NCI-CC 达到 TO 的患者相比，在 DCC 达到 TO 的患者的医疗保险支出明显更低。
尽管 DCC 更频繁地照顾患有高合并症负担的患者，但与 NCI-CC 和其他美国医院相比，DCC 进行 HP 手术的 TO 几率更高。数据表明，DCC 为 HP 恶性肿瘤患者提供了更高价值的手术护理。
