Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Ann Surg Oncol. 2023 Dec;30(13):8044-8053. doi: 10.1245/s10434-023-14242-4. Epub 2023 Sep 2.
Regionalization of complex surgical procedures may improve healthcare quality. We sought to define the impact of regionalization on access to high-volume hospitals for complex oncologic procedures in the state of California.
The California Department of Health Care Access and Information Database (2012-2016) identified patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PA), or proctectomy (PR). Geospatial analysis was conducted to determine travel patterns. Clustered multivariable regression was performed to assess the probability of receiving care at a high-volume center.
Among 25,070 patients (ES: n = 1216, 4.9%; PN: n = 13,247, 52.8%; PD: n = 3559, 14.2%; PR: n = 7048, 28.1%), 6575 (26.2%) individuals resided within 30 min, 11,046 (44.1%) resided within 30-60 min, 7125 (28.4%) resided within 60-90 min, and 324 (1.3%) resided beyond a 90-min travel window from a high-volume center. Median travel distance was 13.4 miles (interquartile range [IQR] 6.0-28.7). On multivariable regression, patients residing further away were more likely to bypass a low-volume center to undergo care at a high-volume hospital (odds ratio 1.32, 95% confidence interval 1.12-1.55) versus individuals residing closer to high-volume centers. Approximately one-third (29.7%) of patients lived beyond a 1-h travel window to the nearest high-volume hospital, of whom 5% traveled over 90 min. While hospital mortality rates across different travel time windows did not differ, surgery at a high-volume center was associated with an overall 1.2% decrease in in-hospital mortality.
Regionalization of complex cancer surgery may be associated with a significant travel burden for a large subset of patients with complex cancer.
复杂手术的区域化可能会提高医疗质量。我们旨在确定在加利福尼亚州，区域化对接受复杂肿瘤手术的高容量医院的途径的影响。
加利福尼亚州医疗保健准入和信息数据库（2012-2016 年）确定了接受食管切除术（ES）、肺切除术（PN）、胰腺切除术（PA）或直肠切除术（PR）的患者。进行了地理空间分析以确定出行模式。采用聚类多变量回归评估在高容量中心接受治疗的概率。
在 25070 名患者中（ES：n=1216，4.9%；PN：n=13247，52.8%；PD：n=3559，14.2%；PR：n=7048，28.1%），6575 名患者（26.2%）居住在 30 分钟车程内，11046 名患者（44.1%）居住在 30-60 分钟车程内，7125 名患者（28.4%）居住在 60-90 分钟车程内，324 名患者（1.3%）居住在离高容量中心 90 分钟车程以上的地方。中位数旅行距离为 13.4 英里（四分位距 [IQR] 6.0-28.7）。在多变量回归中，居住距离较远的患者更有可能绕过低容量中心，选择在高容量医院接受治疗（优势比 1.32，95%置信区间 1.12-1.55），而居住距离较近的患者则不然。大约三分之一（29.7%）的患者居住在离最近的高容量医院 1 小时车程以外的地方，其中 5%的人旅行时间超过 90 分钟。尽管不同旅行时间窗口的医院死亡率没有差异，但在高容量中心进行手术与院内死亡率整体下降 1.2%相关。
复杂癌症手术的区域化可能会给大部分患有复杂癌症的患者带来巨大的交通负担。
