科研之友
微信
新浪微博
Facebook
分享链接
摘要
Background: Rates of abdominoperineal resection (APR) have been suggested as a solitary surrogate marker for comparing overall hospital quality in rectal cancer surgery. This study investigated the value of this marker by examining the associations between hospital APR rates and other quality indicators. Methods: Hospital-level correlations between risk-adjusted APR rates for low rectal cancer and six risk-adjusted outcomes and six care processes were performed (such as 30-day mortality, complications, timely treatment). The ability of APR rates to discriminate between hospitals' performance was examined by means of hospital variance results in multilevel regression models and funnel plots. Results: A linked population-based data set identified 1703 patients diagnosed in 2007 and 2008 who underwent surgery for rectal cancer. Some 15 center dot 9 (95 per cent confidence interval (c.i.) 14 center dot 2 to 17 center dot 6) per cent of these patients had an APR. Among 707 people with low rectal cancer, 38 center dot 2 (34 center dot 6 to 41 center dot 8) per cent underwent APR. Although risk-adjusted hospital rates of APR for low rectal cancer varied by up to 100 per cent, only one hospital (1 per cent) fell outside funnel plot limits and hospital variance in multilevel models was not very large. Lower hospital rates of APR for low rectal cancer did not correlate significantly with better hospital-level outcomes or process measures, except for recording of pathological stage (r = -0 center dot 55, P = 0 center dot 019). Patients were significantly more likely to undergo APR for low rectal cancer if they attended a non-tertiary metropolitan hospital (adjusted odds ratio 2 center dot 14, 95 per cent c.i. 1 center dot 11 to 4 center dot 15). Conclusion: APR rates do not appear to be a useful surrogate marker of overall hospital performance in rectal cancer surgery.
- 出版日期2013-11
