From the Department of Otolaryngology - Head & Neck Surgery, Division of Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ont. (Eskander, Enepekides); ICES, Toronto, Ont. (Eskander, Coburn, Gien); Ontario Health - Cancer Care Ontario, Toronto, Ont. (Zanchetta, Coburn, Menalo, Austria, Linton, Su-Myat, Yermakhanova, Irish); Surgical Oncology, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont. (Coburn); Gynecological Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont. (Gien); and the Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ont. (Irish)
From the Department of Otolaryngology - Head & Neck Surgery, Division of Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ont. (Eskander, Enepekides); ICES, Toronto, Ont. (Eskander, Coburn, Gien); Ontario Health - Cancer Care Ontario, Toronto, Ont. (Zanchetta, Coburn, Menalo, Austria, Linton, Su-Myat, Yermakhanova, Irish); Surgical Oncology, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont. (Coburn); Gynecological Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont. (Gien); and the Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ont. (Irish).
Can J Surg. 2022 Nov 16;65(6):E782-E791. doi: 10.1503/cjs.012521. Print 2022 Nov-Dec.
Cancer surgery cancellation can have negative consequences for the patient, the surgeon and the health care system. There is a paucity of literature on cancer surgery cancellation and its association with wait times, perioperative outcomes, survival and costs of care. Therefore, the objective of this study was to determine the incidence of same-day cancer surgery cancellation in a universal health care context and its association with short and long-term outcomes.
This was a population-based retrospective cancer cohort study in Ontario, Canada (2010-2016). There were 199 599 patients in the control cohort and 3539 patients in the cohort that experienced a cancellation. We assessed the cohorts for differences in survival, perioperative complications and costs of care.
The overall cancellation rate was 1.74% and was predicted by cancer type (genitourinary), lower income quintile, and more central region of residence. Wait times in the cancelled cohort were longer than in the control cohort; however, this difference was not associated with worse survival outcomes. Patients in the cancelled cohort had higher complication rates while in hospital (7.3 %) than those in the control cohort (4.9%; < 0.01). After adjusting for important confounders, the cancelled cohort was more costly ($1100).
Same-day cancer surgery cancellation rates were low. They were associated with longer wait times, higher complication rates and increased costs of care. Survival was not worse in the cancelled cohort, suggesting that appropriate cancer urgency prioritization occurs. Preventable causes of cancellation should be targeted to improve outcomes in patients with cancer.
癌症手术的取消会给患者、外科医生和医疗保健系统带来负面影响。目前，关于癌症手术取消及其与等待时间、围手术期结局、生存和医疗成本之间的关联的文献很少。因此，本研究的目的是确定在全民医疗保健背景下，当天取消癌症手术的发生率及其与短期和长期结局的关联。
这是加拿大安大略省的一项基于人群的回顾性癌症队列研究（2010-2016 年）。对照组有 199599 名患者，取消组有 3539 名患者。我们评估了两组患者的生存、围手术期并发症和医疗成本差异。
总的取消率为 1.74%，可由癌症类型（泌尿生殖系统）、较低的收入五分位数和更中心的居住区域预测。取消组的等待时间长于对照组；然而，这种差异与生存结局较差无关。取消组的住院期间并发症发生率（7.3%）高于对照组（4.9%；<0.01）。在调整了重要混杂因素后，取消组的成本更高（1100 美元）。
当天取消癌症手术的比例较低。它们与较长的等待时间、更高的并发症发生率和增加的医疗成本有关。取消组的生存率并不差，这表明对癌症进行了适当的紧急程度分类。应针对可预防的取消原因进行干预，以改善癌症患者的结局。
