Wright Frances C, Milkovich John, Hunter Amber, Darling Gail, Irish Jonathan
Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2023 Dec;166(6):1502-1509. doi: 10.1016/j.jtcvs.2023.03.002. Epub 2023 Mar 10.
The consolidation of surgical practices has been suggested to improve patient outcomes for complex surgeries. In 2005, Ontario Health-Cancer Care Ontario released the Thoracic Surgical Oncology Standards to facilitate the regionalization process at thoracic centers in Ontario, Canada. This work describes the quality-improvement process involved in updating the minimum surgical volume and supporting requirement recommendations for thoracic centers to further optimize patient care for esophageal cancer.
We conducted a literature review to identify and synthesize evidence informing the volume-outcome relationship related to esophagectomy. The results of this review and esophageal cancer surgery common indicators (reoperation rate, unplanned visit rate, 30-day and 90-day mortality) from Ontario's Surgical Quality Indicator Report were presented and reviewed by a Thoracic Esophageal Standards Expert Panel and Surgical Oncology Program Leads at Ontario Health-Cancer Care Ontario. Hospital outliers were identified, and a subgroup analysis was conducted to determine the most appropriate minimum surgical volume threshold based on 30- and 90-day mortality rates data from the last 3 fiscal years.
Based on the finding that a significant decrease in mortality occurred at 12 to 15 esophagectomies per year, the Thoracic Esophageal Standards Expert Panel reached a consensus that thoracic centers should perform a minimum of 15 esophagectomies per year. The panel also recommended that any center performing esophagectomies have at least 3 thoracic surgeons to ensure continuity in clinical care.
We have described the process involved in updating the provincial minimum volume threshold and the appropriate support services for esophageal cancer surgery in Ontario.
有人认为外科手术的整合有助于改善复杂手术的患者预后。2005年，安大略省卫生厅癌症护理安大略分部发布了胸外科肿瘤学标准，以促进加拿大安大略省胸科中心的区域化进程。本文描述了更新胸科中心食管癌手术最低手术量及支持要求建议所涉及的质量改进过程，以进一步优化患者护理。
我们进行了一项文献综述，以识别和综合有关食管切除术的手术量与预后关系的证据。该综述结果以及安大略省手术质量指标报告中的食管癌手术常见指标（再次手术率、非计划就诊率、30天和90天死亡率）由胸段食管标准专家小组以及安大略省卫生厅癌症护理安大略分部的外科肿瘤学项目负责人进行了展示和审查。确定了医院离群值，并进行了亚组分析，以根据过去3个财政年度的30天和90天死亡率数据确定最合适的最低手术量阈值。
基于每年进行12至15例食管切除术后死亡率显著下降这一发现，胸段食管标准专家小组达成共识，胸科中心每年应至少进行15例食管切除术。该小组还建议，任何进行食管切除术的中心至少应有3名胸外科医生，以确保临床护理的连续性。
我们描述了安大略省更新省级最低手术量阈值以及食管癌手术适当支持服务所涉及的过程。
