Castro-Cuarán María Fernanda, Junca Edgar German, Gonzalez-Patiño Diego Felipe, Buitrago Giancarlo
Universidad Nacional de Colombia, Faculty of Medicine, Department of Surgery - Bogotá (DC), Colômbia.
Hospital Universitario Nacional de Colombia, Department of Surgery, Bogotá (DC), Colômbia.
Arq Bras Cir Dig. 2024 Dec 2;37:e1835. doi: 10.1590/0102-6720202400041e1835. eCollection 2024.
Colon cancer is the third most common malignancy in Colombia, only exceeded by prostate and breast cancers. It is the second most common cancer among females and the third most common among males. The epidemiology of this disease has changed in Colombia, and its peak incidence has now surpassed that of gastric cancer.
We aimed to determine the association between hospital surgical volume and mortality in patients with colon cancer undergoing surgical resection in Colombia.
This was a national retrospective cohort study based on administrative data and included adult patients undergoing surgical resection for colon cancer who were enrolled in Colombia's contributory health system between 2012 and 2017. We defined exposure as the hospital's surgical volume where the colon cancer surgery was performed. We classified the patients as exposed to a high surgical volume (above the 90th percentile of the provider distribution) and a low surgical volume (under the 90th percentile). The main outcomes were 30-day and 1-year mortality. Multivariate Poisson regressions were used to identify the association between exposure and mortality rates.
The study included 4,647 patients, of which 4,188 underwent surgery at hospitals with a colectomy volume lower than 33 per year and 459 underwent surgery at institutions with volumes equal to or higher than 33 per year. In the multivariate analysis, after adjusting for observable variables, a lower risk of 30-day mortality was found in patients who underwent surgery at high surgical volume institutions (relative risk - RR 0.57, 95% confidence interval - 95%CI 0.033-0.97). No differences were found in the one-year mortality.
The high surgical volume of a hospital is associated with a 30-day mortality in colon cancer, as described in other studies, but the 1-year mortality did not show this association. Prospective studies are required to establish a causal relationship.
结肠癌是哥伦比亚第三大常见恶性肿瘤，仅次于前列腺癌和乳腺癌。它是女性中第二常见的癌症，男性中第三常见的癌症。哥伦比亚这种疾病的流行病学已经发生变化，其发病率峰值现已超过胃癌。
我们旨在确定哥伦比亚接受手术切除的结肠癌患者的医院手术量与死亡率之间的关联。
这是一项基于行政数据的全国性回顾性队列研究，纳入了2012年至2017年期间在哥伦比亚缴费型医疗系统登记的接受结肠癌手术切除的成年患者。我们将暴露定义为进行结肠癌手术的医院手术量。我们将患者分为高手术量暴露组（高于提供者分布的第90百分位数）和低手术量暴露组（低于第90百分位数）。主要结局是30天和1年死亡率。使用多变量泊松回归来确定暴露与死亡率之间的关联。
该研究纳入了4647名患者，其中4188名在每年结肠切除术量低于33例的医院接受手术，459名在每年手术量等于或高于33例的机构接受手术。在多变量分析中，在调整了可观察变量后，发现高手术量机构接受手术的患者30天死亡风险较低（相对风险 - RR 0.57，95%置信区间 - 95%CI 0.033 - 0.97）。1年死亡率未发现差异。
正如其他研究所述，医院的高手术量与结肠癌的30天死亡率相关，但1年死亡率未显示这种关联。需要进行前瞻性研究来建立因果关系。
