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首页> 外文期刊>Journal of Thoracic Disease >Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes
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Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes

机译：胸外科手术的区域化改善了短期食管癌切除术的预后

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Background: Some studies have found that outcomes from cancer esophagectomy are better at higher-volume centers than at lower-volume centers. Reports on outcomes following systematic centralization have largely demonstrated subsequent improvements, but these originate in nationalized healthcare systems that are not very comparable to the heterogeneous private-payer systems that predominate in the United States. We examined how regionalization of thoracic surgery to Centers of Excellence (CoE) within our American integrated healthcare system changed overall care for our patients, and whether it changed outcomes. Methods: We conducted a retrospective chart review of 461 consecutive patients undergoing cancer esophagectomy between 2009–2016, spanning the 2014 shift to regionalization. High-volume was defined as ≥5 esophagectomies per year. We compared characteristics of the surgeon, hospital, and operation pre- and post-regionalization using Chi-square or Fisher’s exact test for categorical variables and Kruskal-Wallis test for age. We evaluated their associations with patient outcomes with hierarchical linear and logistic mixed models, which adjusted for clustering within surgeon and facility levels and relevant covariates. Results: While there was no difference in their baseline demographics, patients undergoing esophagectomy post-regionalization were much more likely to have their surgery performed at a designated Center of Excellence (78.8% of cases versus 34.2%, P Conclusions: Regionalization of thoracic surgery in our hospital system resulted in esophagectomies being performed by more experienced surgeons at higher-volume centers, with a concomitant improvement in short-term outcomes. Patients undergoing esophagectomy, particularly MIE, post-regionalization benefited significantly from decreased LOS and perioperative complication rate. Our results suggest that, in a large integrated healthcare system, regionalization significantly improves overall outcomes for patients undergoing cancer esophagectomy.
机译：背景：一些研究发现，食管切除术在大容量中心要比小容量中心更好。关于系统集中化后结果的报告在很大程度上证明了其后的改进，但是这些改进源自国有化的医疗体系，与在美国占主导地位的异类私人付款者体系相比并不太可比。我们研究了在美国综合医疗体系内将胸外科手术区域化到卓越中心（CoE）的方式如何改变了患者的整体护理，以及它是否改变了结果。方法：我们对2009年至2016年间连续461例接受癌症食管切除术的患者进行了回顾性图表回顾，涵盖了2014年转向区域化的情况。高容量被定义为每年≥5次食管切开术。我们使用卡方检验或Fisher精确检验（用于分类变量）和Kruskal-Wallis检验（年龄）来比较外科医生，医院和手术前后区域化的特征。我们使用分层线性和逻辑混合模型评估了他们与患者结果的关联，该模型针对外科医生和机构级别以及相关协变量的聚类进行了调整。结果：尽管基线人口统计学没有差异，但是在区域化后接受食管切除术的患者更有可能在指定的卓越中心进行手术（78.8％的病例与34.2％的病例比较，P结论）：我们的医院系统导致较大容量中心的经验丰富的外科医师进行食管切开术，同时短期效果也得到改善，进行食管切除术（尤其是MIE）的患者在区域化后受益于LOS降低和围手术期并发症发生率显着提高。提示，在大型综合医疗系统中，区域化可显着改善接受食管癌切除术的患者的总体预后。

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