消化管切除术的动态体积-结果关联:当前的体积值是否仍然适用?
Kristen Jogerst1, Chi Zhang2, Yu-Hui Chang3
1Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Surgery
|June 4, 2024
概括
消化管切除术的最低医院病例数量已经减少. 2015年每年7例的门实现了与以前20例类似的30天死亡率,这表明需要更新标准.
科学领域:
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 目前对食道切除术的医院病例数量建议可能并不反映当代实践.
- 只有1.1%的机构达到每年每医院20例的最低标准.
研究的目的:
- 评估目前对食道切除术的最低病例量建议的适用性.
- 评估30天死亡率的趋势,并确定建议的体积值是否仍然相关.
主要方法:
- 在国家癌症数据库中对2005-2015年食道切除数据的分析.
- 根据四分位数,医院被分为低,中和高体积层.
- 后勤回归用于计算调整后的30天死亡率和分析趋势.
主要成果:
- 对食道切除术的30天整体未调整的死亡率为3.8%.
- 在2005年至2015年期间,调整后的30天死亡率在所有体积层下降.
- 到2015年,每年7例病例的调整后30天死亡率与整体队列中的20例病例相似.
结论:
- 只有很小一部分医院符合目前的20例食道切除术的最低限度.
- 医疗保健的改善降低了死亡率,使得较低的体积值可以实现.
- 修订体积建议可以提高获得优质食道切除术护理的机会.
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