当前位置： SCI文献检索 > JAMA Surgery期刊下所有文献 > Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.

Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.

Abstract：

IMPORTANCE:Wide variations in mortality rates exist across hospitals following lung cancer resection; however, the factors underlying these differences remain unclear. OBJECTIVE:To evaluate perioperative outcomes in patients who underwent lung cancer resection at hospitals with very high and very low mortality rates (high-mortality hospitals [HMHs] and low-mortality hospitals [LMHs]) to better understand the factors related to differences in mortality rates after lung cancer resection. DESIGN, SETTING, AND PARTICIPANTS:In this retrospective cohort study, 1279 hospitals that were accredited by the Commission on Cancer were ranked on a composite measure of risk-adjusted mortality following major cancer resections performed from January 1, 2005, through December 31, 2006. We collected data from January 1, 2006, through December 31, 2007, on 645 lung resections in 18 LMHs and 25 HMHs. After adjusting for patient characteristics, we used hierarchical logistic regression to examine differences in the incidence of complications and "failure-to-rescue" rates (defined as death following a complication). MAIN OUTCOMES AND MEASURES:Rates of adherence to processes of care, incidence of complications, and failure to rescue following complications. RESULTS:Among 645 patients who received lung resections (441 in LMHs and 204 in HMHs), the overall unadjusted mortality rates were 1.6% (n = 7) vs 10.8% (n = 22; P < .001) for LMHs and HMHs, respectively. Following risk adjustment, the difference in mortality rates was attenuated (1.8% vs 8.1%; P < .001) but remained significant. Overall, complication rates were higher in HMHs (23.3% vs 15.6%; adjusted odds ratio [aOR], 1.79; 95% CI, 0.99-3.21), but this difference was not significant. The likelihood of any surgical (aOR, 0.73; 95% CI, 0.26-2.00) or cardiopulmonary (aOR, 1.23; 95% CI, 0.70-2.16) complications was similar between LMHs and HMHs. However, failure-to-rescue rates were significantly higher in HMHs (25.9% vs 8.7%; aOR, 6.55; 95% CI, 1.44-29.88). CONCLUSIONS AND RELEVANCE:Failure-to-rescue rates are higher at HMHs, which may explain the large differences between hospitals in mortality rates following lung cancer resection. This finding emphasizes the need for better understanding of the factors related to complications and their subsequent management.

journal_name

JAMA Surg

journal_title

JAMA surgery

authors

Grenda TR,Revels SL,Yin H,Birkmeyer JD,Wong SL

doi

10.1001/jamasurg.2015.2199

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

1034-40

issue

eissn

2168-6254

issn

2168-6262

pii

2417314

journal_volume

150

pub_type

杂志文章,多中心研究

在线工具

Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.