Department of Surgery, Duke University Medical Center, Durham, NC, U.S.A.
Anticancer Res. 2020 Apr;40(4):2107-2115. doi: 10.21873/anticanres.14169.
BACKGROUND/AIM: Recently, the concept of textbook outcome (TO) has emerged as a novel effort to develop a benchmark that reflects multiple domains of quality. The aims of the current study were to define TO for retroperitoneal sarcoma (RPS), evaluate the relationship of TO with hospital volume and assess the association of TO with overall survival.
Patients who underwent resection for RPS diagnosed between 2004 and 2015 were identified in the National Cancer Database. The primary outcome was TO that was defined as: hospital length of stay<75 percentile, survival>90 days from surgery, no readmission within 30 days and grossly negative margins.
Of the 11,032 patients analyzed, 54.0% had a TO. Among patients who had a TO, 57.8% were treated in high-volume hospitals. Undergoing surgery at high-volume centers was associated with a higher probability of a TO (p=0.009). TO were associated with significantly longer overall survival (p<0.001). In a subgroup analysis with grossly negative margins and no 90-day mortality, the association of TO with improved survival persisted (p<0.001).
The concept of TO is a promising tool for measuring patient-level hospital performance and may be useful for identifying important variations in care for patients with RPS.
背景/目的：最近，教科书结局（Textbook Outcome，TO）的概念作为一种新兴的努力被提出，旨在开发一个反映多个质量领域的基准。本研究的目的是为腹膜后肉瘤（RPS）定义 TO，评估 TO 与医院容量的关系，并评估 TO 与总生存的相关性。
在国家癌症数据库中确定了 2004 年至 2015 年间接受 RPS 切除术的患者。主要结局是 TO，定义为：住院时间<75 百分位数，手术后 90 天以上生存，30 天内无再入院，大体切缘阴性。
在分析的 11032 名患者中，54.0%有 TO。在有 TO 的患者中，57.8%在高容量医院接受治疗。在高容量中心接受手术与更高的 TO 可能性相关（p=0.009）。TO 与显著延长的总体生存相关（p<0.001）。在大体切缘阴性和无 90 天死亡率的亚组分析中，TO 与改善的生存相关仍然存在（p<0.001）。
TO 的概念是衡量患者层面医院绩效的有前途的工具，可能有助于识别腹膜后肉瘤患者护理中的重要差异。
