J Clin Oncol：高收容量医院治疗的卵巢癌患者或死亡率更低

近日，来自赫伯特-欧文综合癌症研究中心的研究者通过研究揭示了，相比在收容量低的医院进行治疗，卵巢癌女性在手容量高的医院治疗的效果或许会更好一些，相关研究成果刊登于国际杂志Journal of Clinical Oncology上。

患者的生存率并不是依赖于术后低的并发症率，而是取决于并发症的治疗效果。事实上，在低收容量的医院，有并发症的病人会有50%的死亡率，相比高收容量的医院，死亡率高很多。研究者Wright表示，手术量对于患者术后恢复有很大的影响，我们对三个方面进行了评估：收容量对并发症的影响、患者并发症救治失败以及卵巢癌患者的住院总死亡率，这三方面都是针对正在进行癌症相关手术患者方面的调查研究，随后研究者表示，患者的死亡率并不是和并发症的比率一致的。

对于在低收容量的并发症妇女来说，其死亡率为8%；而在高手容量医院的患者，死亡率为4.9%。研究者发现，在低收容量医院的患者急救失败率为48%，远高于在高收容量医院的急救失败率。

研究者对1998年至2009年的数据进行了分析，数据包括19至90岁进行过卵巢癌切除术的卵巢癌患者，超过36，000个患者，有1，166名患者进行了长期的医院治疗。对这些数据进行分析后，研究者得出了几条结论，比如，并发症率随着外科手术量的增加而增加，低收容量医院为20.4%，而高手容量医院为24.6%。

尽管研究者并不能确定所有影响结论的因素，但是研究发现对于卵巢癌患者的治疗和护理缺失具有重要的指示意义。研究者Dawn说，我们的研究发现为改善并发症患者的生活质量以及治疗效果提出了一些合理的建议。

基于此项研究，研究者揭示出了预防患者术后并发症的重要性，因为术后并发症能增加患者的死亡率，以及较差的健康状况，这就带来了长期的服药问题，同时也使得患者的家庭面对困难的治疗选择以及额外的费用。

编译自：Ovarian Cancer Patients Have Lower Mortality Rates When Treated at High-Volume Hospitals

doi:10.1200/JCO.2012.43.2906
PMC:
PMID:

Failure to Rescue As a Source of Variation in Hospital Mortality for Ovarian Cancer

Jason D. Wright⇓, Thomas J. Herzog, Zainab Siddiq, Rebecca Arend, Alfred I. Neugut, William M. Burke, Sharyn N. Lewin, Cande V. Ananth and Dawn L. Hershman

Purpose Although the association between high surgical volume and improved outcomes from procedures is well described, the mechanisms that underlie this association are uncertain. There is growing recognition that high-volume hospitals may not necessarily have lower complication rates but rather may be better at rescuing patients with complications. We examined the role of complications, failure to rescue from complications, and mortality based on hospital volume for ovarian cancer. Patients and Methods The Nationwide Inpatient Sample was used to identify women who underwent surgery for ovarian cancer from 1988 to 2009. Hospitals were ranked on the basis of their procedure volume. We determined the risk-adjusted mortality, major complication rate, and “failure to rescue” rate (mortality in patients with a major complication) for each tertile. Univariate and multivariate associations were then compared. Results We identified 36,624 patients. The mortality rate for the cohort was 1.6%. The major complication rate was 20.4% at low-volume, 23.4% at intermediate-volume, and 24.6% at high-volume hospitals (P < .001). However, the rate of failure to rescue (death after a complication) was markedly higher at low-volume (8.0%) compared with high-volume hospitals (4.9%; P < .001). After accounting for patient and hospital characteristics, women treated at low-volume hospitals who experienced a complication were 48% more likely (odds ratio [OR], 1.48; 95% CI, 1.11 to 1.99) to die than patients with a complication at a high-volume hospital. Conclusion Mortality is lower for patients with ovarian cancer treated at high-volume hospitals. The reduction in mortality does not appear to be the result of lower complications rates but rather a result of the ability of high-volume hospitals to rescue patients with complications.

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