Department of Obstetrics and Gynecology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto.
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto; ICES, Toronto, ON.
J Obstet Gynaecol Can. 2020 Sep;42(9):1093-1102.e3. doi: 10.1016/j.jogc.2020.03.006. Epub 2020 Mar 27.
To evaluate the impact of class III obesity (body mass index >40 kg/m) on wait times for endometrial cancer surgery in Ontario, as well as other factors that influence wait time.
We performed a population-based cross-sectional study evaluating diagnosis-to-surgery time for women with endometrioid adenocarcinoma of the endometrium, during the period of 2006 to 2015, using linked administrative databases. Wait time differences between women with and without class III obesity were evaluated using a Wilcoxon rank-sum test. A multivariable generalized linear model under a generalized estimating equations approach was used to evaluate patient factors (i.e., obesity, age, comorbidities, marginalization, recent immigration, diagnosis year, geographic location), tumour characteristics (i.e., grade, stage), provider type (i.e., surgeon specialty), and institutional characteristics (i.e., rurality, hysterectomy volume, availability of minimally invasive surgery) that influence wait times.
In total, 9797 women met the criteria for inclusion; 2171 (22%) had class III obesity. The overall median wait time was 55 days (interquartile range [IQR] 37-77 d) and the median wait time was significantly longer for women with class III obesity (62 [IQR 43-88] vs. 53 [IQR 36-74] d, standardized mean difference, 0.30). Age <40 or >70 years, comorbidities, lower-grade disease, surgery at an urban teaching hospital, and surgery at a high-volume hospital with greater availability of minimally invasive surgery were associated with longer wait times. After adjusting for these variables, women with class III obesity waited 12% longer.
Class III obesity, comorbidities, and older age are associated with a longer diagnosis-to-surgery time. As the prevalence of obesity and endometrial cancer rise, processes are needed to promote equitable, timely access to care.
评估安大略省 3 类肥胖症（体重指数>40kg/m²）对子宫内膜癌手术等待时间的影响，以及影响等待时间的其他因素。
我们进行了一项基于人群的横断面研究，使用链接的行政数据库评估了 2006 年至 2015 年间患有子宫内膜样腺癌的女性的诊断到手术时间。使用 Wilcoxon 秩和检验评估了肥胖症患者与非肥胖症患者之间的等待时间差异。使用广义估计方程方法下的多变量广义线性模型，评估了影响等待时间的患者因素（即肥胖症、年龄、合并症、边缘化、近期移民、诊断年份、地理位置）、肿瘤特征（即分级、分期）、提供者类型（即外科医生专业）和机构特征（即农村、子宫切除术量、微创手术可用性）。
共有 9797 名女性符合纳入标准；其中 2171 名（22%）患有 3 类肥胖症。总体中位数等待时间为 55 天（四分位距 [IQR] 37-77d），肥胖症患者的中位数等待时间明显更长（62 [IQR 43-88] vs. 53 [IQR 36-74]d，标准化均差，0.30）。年龄<40 岁或>70 岁、合并症、较低分级疾病、在城市教学医院进行手术以及在高容量医院进行手术且微创手术可用性较高，与较长的等待时间相关。在调整了这些变量后，肥胖症患者的等待时间延长了 12%。
3 类肥胖症、合并症和年龄较大与诊断到手术时间的延长有关。随着肥胖症和子宫内膜癌的患病率上升，需要制定流程以促进公平、及时地获得医疗服务。
