Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany; Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany; Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.
Eur J Surg Oncol. 2021 Apr;47(4):850-857. doi: 10.1016/j.ejso.2020.09.024. Epub 2020 Sep 25.
The German Cancer Society ("Deutsche Krebsgesellschaft"; DKG) certifies on a volunteer base colorectal cancer centers based on, among other things, minimum operative amounts (at least 30 oncological colon cancer resections and 20 oncological rectal cancer resections per year). In this work, nationwide hospital mortality and death after documented complications ('Failure to Rescue' = FtR) were evaluated depending on the fulfillment of the minimum amounts.
This is a retrospective analysis of the nationwide hospital billing data (DRG data, 2012-2017). Categorization is based on the DKG minimum quantities (fully, partially or not fulfilled).
Of 287,227 patients analyzed, 56.5% were operated in centers that met the DKG minimum amounts. The overall hospital mortality rate was 5.0%. In centers which met the minimum quantities, it was significantly lower (4.3%) than in hospitals which partially (5.7%) or not (6.2%) met the minimum quantities. The risk-adjusted hospital mortality rate for patients in hospitals who meet the minimum amount was 20% lower (OR 0.80; 95% CI [0.74-0.87], p < 0.001). For complications, both surgical and non-surgical, there was an unadjusted and adjusted lower FtR in hospitals that met the minimum amounts (e.g. anastomotic leak: 11.2% vs. 15.6%, p < 0.001; pulmonary artery embolism 21.3% vs. 28.2%, p = 0.001).
There is a 1/3 lower mortality and FtR rate after surgery for a colon or rectal cancer in centers fulfilling the DKG minimum amounts. The presented data implicate that there is an urgent need for a nationwide centralization program.
德国癌症协会（“Deutsche Krebsgesellschaft”；DKG）基于最低手术量（每年至少 30 例肿瘤性结肠癌切除术和 20 例肿瘤性直肠癌切除术），对结直肠癌中心进行志愿者认证。在这项工作中，根据最低数量的完成情况，评估了全国范围内医院死亡率和有记录并发症后的死亡率（“救援失败”=FtR）。
这是对全国范围内医院计费数据（DRG 数据，2012-2017 年）的回顾性分析。分类基于 DKG 的最低数量（完全、部分或未完成）。
在分析的 287227 名患者中，56.5%在符合 DKG 最低数量的中心接受了手术。总的医院死亡率为 5.0%。在符合最低数量的中心，死亡率显著低于部分（5.7%）或未（6.2%）符合最低数量的医院。符合最低数量的医院患者的风险调整后医院死亡率低 20%（OR 0.80；95%CI [0.74-0.87]，p<0.001）。对于手术和非手术并发症，符合最低数量的医院的未调整和调整后的 FtR 均较低（例如吻合口漏：11.2%比 15.6%，p<0.001；肺动脉栓塞 21.3%比 28.2%，p=0.001）。
在符合 DKG 最低数量的中心进行结肠或直肠手术后，死亡率和 FtR 率降低了 1/3。所提供的数据表明，迫切需要制定全国性的集中化计划。
