Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Ann Surg Oncol. 2024 Feb;31(2):1049-1057. doi: 10.1245/s10434-023-14450-y. Epub 2023 Oct 31.
For some cancer operations, center volume is associated with improved patient outcomes. Whether this association is true for cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) is unclear. Given the rapidly expanding use of CRS/HIPEC, the aim of this analysis was to determine whether a volume-outcome relationship exists for this strategy.
The Vizient Clinical Database® was queried for CRS/HIPEC cases from January 2020 through December 2022. Low-, medium-, and high-volume designations were made by sorting hospitals by case volume and creating equal tertiles based on total number of cases. Analysis was performed via one-way ANOVA with post-hoc Tukey test, as indicated.
In the 36-month study period, 5165 cases were identified across 149 hospitals. Low- (n = 113), medium- (n = 25), and high-volume (n = 11) centers performed a median of 4, 21, and 47 cases per annum, respectively. Most cases were performed for appendiceal (39.3%) followed by gynecologic neoplasms (20.4%). Groups were similar with respect to age, gender, race, comorbidities, and histology. Low-volume centers were more likely to utilize the ICU post-operatively (59.6% vs. 40.5% vs. 36.3%; p = 0.02). No differences were observed in morbidity (9.4% vs. 7.1% vs. 9.0%, p = 0.71), mortality (0.9% vs. 0.6% vs. 0.7%, p = 0.93), length of stay (9.3 vs. 9.4 vs. 10 days, p = 0.83), 30-day readmissions (5.6% vs. 5.6% vs. 5.6%, p = 1.0), or total cost among groups.
No association was found between CRS/HIPEC hospital volume and post-operative outcomes. These data suggest that in academic medical centers with HIPEC programs, outcomes for commonly treated cancers are not associated with hospital volume.
对于某些癌症手术，中心容量与患者预后改善相关。对于细胞减灭术/加热腹腔内化疗（CRS/HIPEC）是否存在这种关联尚不清楚。鉴于 CRS/HIPEC 的应用迅速扩大，本分析旨在确定该策略是否存在容量与结果的关系。
使用 Vizient Clinical Database® 查询 2020 年 1 月至 2022 年 12 月的 CRS/HIPEC 病例。根据病例量对医院进行排序，并根据总病例数创建相等的三分位数，从而确定低、中、高容量。如有需要，采用单向方差分析和事后 Tukey 检验进行分析。
在 36 个月的研究期间，在 149 家医院中确定了 5165 例病例。低（n = 113）、中（n = 25）和高（n = 11）容量中心每年分别进行中位数为 4、21 和 47 例手术。大多数病例是为阑尾（39.3%）和妇科肿瘤（20.4%）进行的。各组在年龄、性别、种族、合并症和组织学方面相似。低容量中心术后更有可能使用 ICU（59.6%比 40.5%比 36.3%；p = 0.02）。各组之间的发病率（9.4%比 7.1%比 9.0%，p = 0.71）、死亡率（0.9%比 0.6%比 0.7%，p = 0.93）、住院时间（9.3 天比 9.4 天比 10 天，p = 0.83）、30 天再入院率（5.6%比 5.6%比 5.6%，p = 1.0）或总费用均无差异。
CRS/HIPEC 医院容量与术后结果之间没有关联。这些数据表明，在具有 HIPEC 计划的学术医疗中心，常见癌症的治疗结果与医院容量无关。
