Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
Duke University School of Medicine, Durham, NC, USA.
J Gastrointest Surg. 2021 May;25(5):1287-1296. doi: 10.1007/s11605-020-04760-x. Epub 2020 Aug 4.
To evaluate health care fragmentation in patients with stage II and III rectal cancers.
Fragmentation of care among multiple hospitals may worsen outcomes for cancer patients.
National Cancer Database was queried for adult patients who underwent radiation and surgery for locally advanced (stage II-III) rectal adenocarcinoma from 2006 to 2015. Fragmented care was defined as receiving radiation at a different hospital from surgery. Descriptive statistics characterized patients, and survival probability was plotted using the Kaplan-Meier method and a Cox proportional hazards model.
A total of 37,081 patients underwent surgery and radiation for stage II-III rectal cancer from 2006 to 2015 (24,102 integrated care vs. 12,979 fragmented care). Patients who received fragmented care (hazard ratio [HR] 1.105; 95% CI 1.045-1.169) had a higher risk of mortality. Patients who received at least surgery (HR 0.84; 95% CI 0.77-0.92) at academic hospitals had a lower risk of mortality. Academic hospitals had a higher proportion of patients with fragmented care (38.0 vs. comprehensive community 32.8% vs. community 33.8%, p < 0.001). Within academic hospitals, fragmented care portended worse survival (integrated academic 80.0% vs. fragmented academic 76.7%, p = 0.0002). Fragmented care at academic hospitals had increased survival over integrated care at community hospitals (fragmented academic 76.7 vs. integrated community 72.2%, p = 0.00039).
In patients with stage II-III rectal cancer, patients who have integrated care at academic hospitals or at least surgery at academic centers had better survival. All efforts should be made to reduce care fragmentation and surgery at academic centers should be prioritized.
评估 II 期和 III 期直肠癌患者的医疗保健碎片化情况。
多家医院之间的护理碎片化可能会使癌症患者的治疗结果恶化。
从 2006 年至 2015 年，国家癌症数据库（National Cancer Database）对接受局部晚期（II-III 期）直肠腺癌放疗和手术的成年患者进行了查询。将在不同医院接受放疗的患者定义为接受不同医院的治疗。描述性统计方法对患者进行了描述，Kaplan-Meier 法和 Cox 比例风险模型绘制了生存概率图。
共有 37081 名患者在 2006 年至 2015 年间接受了 II-III 期直肠癌的手术和放疗（24102 例综合护理与 12979 例护理碎片化）。接受护理碎片化的患者（风险比 [HR] 1.105；95%置信区间 1.045-1.169）的死亡率更高。在学术医院至少接受手术的患者（HR 0.84；95%置信区间 0.77-0.92）的死亡率更低。学术医院接受护理碎片化的患者比例较高（38.0%比综合社区 32.8%比社区 33.8%，p<0.001）。在学术医院中，护理碎片化预示着生存率降低（综合学术 80.0%比碎片化学术 76.7%，p=0.0002）。学术医院的护理碎片化比社区医院的综合护理更能提高生存率（碎片化学术 76.7%比综合社区 72.2%，p=0.00039）。
在 II 期和 III 期直肠癌患者中，在学术医院接受综合护理或至少在学术中心接受手术的患者生存状况更好。应尽一切努力减少护理碎片化，应优先考虑在学术中心进行手术。
