David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California, United States of America.
PLoS One. 2021 Dec 8;16(12):e0260255. doi: 10.1371/journal.pone.0260255. eCollection 2021.
To identify patient and hospital characteristics associated with extended surgical cytoreduction in the treatment of ovarian cancer.
A retrospective analysis using the National Inpatient Sample (NIS) database identified women hospitalized for surgery to remove an ovarian malignancy between 2013 and 2017. Extended cytoreduction (ECR) was defined as surgery involving the bowel, liver, diaphragm, bladder, stomach, or spleen. Chi-square and logistic regression were used to analyze patient and hospital demographics related to ECR, and trends were assessed using the Cochran-Armitage test.
Of the estimated 79,400 patients undergoing ovarian cancer surgery, 22% received ECR. Decreased adjusted odds of ECR were found in patients with lower Elixhauser Comorbidity Index (ECI) scores (OR 0.61, p<0.001 for ECI 2, versus ECI≥3) or residence outside the top income quartile (OR 0.71, p<0.001 for Q1, versus Q4), and increased odds were seen at hospitals with high ovarian cancer surgical volume (OR 1.25, p<0.001, versus low volume). From 2013 to 2017, there was a decrease in the proportion of cases with extended procedures (19% to 15%, p<0.001). There were significant decreases in the proportion of cases with small bowel, colon, and rectosigmoid resections (p<0.001). Patients who underwent ECR were more likely treated at a high surgical volume hospital (37% vs 31%, p<0.001) over the study period. For their hospital admission, patients who underwent ECR had increased mortality (1.6% vs. 0.5%, p<0.001), length of stay (9.6 days vs. 5.2 days, p<0.001), and mean cost ($32,132 vs. $17,363, p<0.001).
Likelihood of ECR was associated with increased medical comorbidity complexity, higher income, and undergoing the procedure at high surgical volume hospitals. The proportion of ovarian cancer cases with ECR has decreased from 2013-17, with more cases performed at high surgical volume hospitals.
确定与卵巢癌治疗中扩大手术减瘤相关的患者和医院特征。
使用国家住院患者样本（NIS）数据库进行回顾性分析，确定 2013 年至 2017 年间因手术切除卵巢恶性肿瘤而住院的女性。扩大细胞减灭术（ECR）定义为涉及肠、肝、膈肌、膀胱、胃或脾脏的手术。采用卡方检验和逻辑回归分析与 ECR 相关的患者和医院人口统计学特征，并使用 Cochran-Armitage 检验评估趋势。
在接受卵巢癌手术的约 79400 名患者中，有 22%接受了 ECR。Elixhauser 合并症指数（ECI）评分较低的患者（ECI 2 分与 ECI≥3 分相比，调整后 ECR 的可能性降低 0.61，p<0.001）或居住在收入最高四分位数之外的患者（Q1 与 Q4 相比，调整后 ECR 的可能性降低 0.71，p<0.001），ECR 的可能性较低。在卵巢癌手术量较高的医院，ECR 的可能性增加（OR 1.25，p<0.001，与低容量相比）。2013 年至 2017 年，扩大手术的病例比例从 19%下降至 15%（p<0.001）。小肠、结肠和直肠乙状结肠切除术的比例显著下降（p<0.001）。接受 ECR 的患者更有可能在手术量较高的医院接受治疗（37%比 31%，p<0.001）。在整个研究期间，接受 ECR 的患者的死亡率（1.6%比 0.5%，p<0.001）、住院时间（9.6 天比 5.2 天，p<0.001）和平均费用（32132 美元比 17363 美元，p<0.001）均有所增加。
ECR 的可能性与增加的医疗合并症复杂性、更高的收入以及在手术量较高的医院进行手术有关。2013-17 年，卵巢癌病例中 ECR 的比例有所下降，在手术量较高的医院进行的病例更多。
