在Whipple手术中医院体积和健康公平:谁落后
Colette R Pameijer1, Mohammad Ikram2, Chan Shen2,3
1Department of Surgery, Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
The American surgeon
|November 15, 2025
概括
在困难社区接受胰腺二管切除术 (PD) 的患者往往去较低体积的医院,尽管在中等体积的中心的结果相似. 中型医院提供了可行的替代方案,改善了这些患者的获取和治疗结果.
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
- 健康差异 在健康上的差异
背景情况:
- 胰腺双管切除术 (PD) 是一项复杂的手术,其结果受医院体积的影响.
- 社会经济地位和护理地点对PD结果的影响仍未得到充分研究.
- 进入高人数中心的差异可能会影响困难社区的患者群体.
研究的目的:
- 为了研究胰腺管切除术中医院体积,患者结果和社会经济因素之间的关系.
- 识别来自困境社区的患者获得护理的差异.
- 为了评估中等与高体积的PD手术中心的比较有效性.
主要方法:
- 对全州医院出院数据库 (宾夕法尼亚州,2017-2021) 的分析,包括1316例PD病例.
- 医院按总手术数量 (最低,中,高) 分类.
- 多变量后勤回归调整为患者人口统计学,医院特征和困难社区指数 (DCI) 评分,以评估死亡率,再入院和出院处置.
主要成果:
- 容量最小的医院的患者更有可能居住在困难社区.
- 在中型和高容量医院之间没有观察到死亡率,30天再入院或非例行出院的显著差异.
- 在来自困境社区的患者中,结果在中型和高容量医院之间是相似的,与中型容量中心的旅行距离相似.
结论:
- 来自困难社区的城市患者不成比例地在体积最低的中心接受护理,经历了更糟糕的结果.
- 中等体积的医院表现出与PD手术的高体积中心相似的临床结果.
- 中等体积中心对来自困难社区的患者来说是一个可行的替代方案,他们面临着进入高体积护理的障碍.
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