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首页> 外文期刊>Cancer Management and Research >Decentralized colorectal cancer care in Germany over the last decade is associated with high in-hospital morbidity and mortality
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Decentralized colorectal cancer care in Germany over the last decade is associated with high in-hospital morbidity and mortality

机译：在过去十年中，德国大肠癌的分散护理与医院内高发病率和高死亡率相关

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Purpose: Despite several national initiatives, centralization of cancer care in Germany remains insufficient for most malignancies. Currently, there is a plethora of centers, including 290 voluntary certified and audited colorectal cancer (CRC) centers by the end of 2017, in the nation with many patients still being treated outside of such centers. This study aimed to assess morbidity and mortality rates of surgical procedures for primary colorectal CRC in Germany over the last decade through a comprehensive unbiased analysis. Patients and methods: We performed an analysis of the national diagnosis-related group inpatient statistics from 2005 to 2015 including all German hospitals. All patients who underwent surgeries for primary CRC during the study period were included. Results: A total of 351,028 cases were analyzed (61.6% colonic and 38.4% rectal resections). The mortality rate of colonic resections remained high during the study period (4.9% in 2005 vs 4.5% in 2015; P =0.57). Reduced perioperative mortality after rectal surgery was observed only after 2012 compared to previous years (3.8% in 2005 vs 3.0% in 2015; P 0.001), with no further improvement. In-hospital morbidity such as anastomotic leak, wound infections, hemorrhage, pneumonia, deep vein thrombosis, and lung embolism did not improve for either rectal or for colonic surgery, but in contrast, most outcomes deteriorated over time. Conclusion: The present study challenges the current national health policies aiming to improve outcomes of surgical patients. CRC care in Germany remains decentralized with high in-hospital morbidity and mortality rates. New national strategies focusing on the implementation of centralization and high-quality CRC care are urgently needed.
机译：目的：尽管采取了多项国家举措，但德国对大多数恶性肿瘤的集中癌症治疗仍然不够。目前，到2017年底，该国有许多中心，包括290个自愿认证和审核的结直肠癌（CRC）中心，许多患者仍在此类中心之外接受治疗。这项研究旨在通过全面的无偏分析评估过去十年来德国原发性结直肠癌外科手术的发病率和死亡率。患者和方法：我们对包括德国所有医院在内的2005年至2015年国家诊断相关人群的住院统计数据进行了分析。在研究期间，所有接受过原发性CRC手术的患者均包括在内。结果：共分析351,028例（结肠切除率为61.6％，直肠癌切除率为38.4％）。在研究期间，结肠切除术的死亡率仍然很高（2005年为4.9％，2015年为4.5％; P = 0.57）。直肠手术后围手术期死亡率仅在2012年之后与往年相比有所下降（2005年为3.8％，2015年为3.0％; P <0.001），没有进一步改善。无论是直肠手术还是结肠手术，诸如吻合口漏，伤口感染，出血，肺炎，深静脉血栓形成和肺栓塞等医院内发病率都没有改善，但是相反，大多数结果随着时间的推移而恶化。结论：本研究对旨在改善手术患者预后的现行国家卫生政策提出了挑战。德国的CRC护理分散化，院内发病率和死亡率很高。迫切需要着重于集中实施和高质量的儿童护理的新的国家战略。

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