Chou Jesse, Somnay Vishal, Woodwyk Alyssa, Munene Gitonga
Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA.
Radiology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA.
Cureus. 2020 Oct 18;12(10):e11023. doi: 10.7759/cureus.11023.
Despite the well-established relationship between volume and outcomes, patients continue to have procedures performed at low-volume hospitals. The factors patients use to make the complex decision of where to have hepatopancreaticobiliary (HPB) surgery remain poorly characterized. A novel survey instrument was administered to all patients who had undergone HPB surgery at two university-affiliated community hospitals. 76 patients participated in the study (89% response rate). The majority of patients were unaware of the volume-outcome relationship (58.8%). No demographic factors differed between patients who were or were not aware except for patient research. Physician factors were the most important selection category (64.4%). Only 28.9% of patients were willing to travel more than two hours to have an operation performed at a hospital with a high volume/improved quality. Despite many voices calling for regionalization, patient decision-making factors should be considered before any realistic implementation.
尽管手术量与治疗结果之间的关系已得到充分证实，但患者仍在低手术量的医院接受手术。患者在做出关于何处进行肝胰胆（HPB）手术这一复杂决定时所采用的因素仍未得到充分描述。一种新型调查问卷被发放给了在两家大学附属医院接受过HPB手术的所有患者。76名患者参与了该研究（回复率为89%）。大多数患者并不知晓手术量与治疗结果之间的关系（58.8%）。除了患者自身的研究情况外，知晓或不知晓这一关系的患者在人口统计学因素上并无差异。医生因素是最重要的选择类别（64.4%）。只有28.9%的患者愿意前往距离超过两小时路程的医院进行手术，该医院手术量高且质量更好。尽管有许多声音呼吁进行区域化，但在任何实际实施之前都应考虑患者的决策因素。
