OBJECTIVES:To investigate volume-outcome relationships in nephrectomy and cystectomy for cancer. MATERIALS AND METHODS:Data were extracted from the UK Hospital Episodes Statistics database, which records data on all National Health Service (NHS) hospital admissions in the England. Data were included for a 5-year period (April 2013-March 2018 inclusive) and data on emergency and paediatric admissions were excluded. Data were extracted on the NHS trust and surgeon undertaking the procedure, the surgical technique used (open, laparoscopic or robot-assisted) and length of hospital stay during the procedure. This dataset was supplemented by data on mortality from the UK Office for National Statistics. A number of volume thresholds and volume measures were investigated. Multilevel modelling was used to adjust for hierarchy and confounding factors. RESULTS:Data were available for 18 107 nephrectomy and 6762 cystectomy procedures for cancer. There was little evidence of trust or surgeon volume influencing readmission rates or mortality. There was some evidence of shorter length of hospital stay for high-volume surgeons, although the volume measure and threshold used were important. CONCLUSIONS:We found little evidence that further centralization of nephrectomy or cystectomy for cancer surgery will improve the patient outcomes investigated. It may be that length of stay can be optimized though training and support for lower-volume centres, rather than further centralization.

译文

目的:探讨在肾切除术和膀胱切除术中癌症的体积-结果关系。
材料与方法:数据来自英国医院情节统计数据库,该数据库记录了英格兰所有国家卫生服务(NHS)医院的入院数据。纳入了5年期间(2013年4月至2018年3月)的数据,但不包括急诊和儿科入院的数据。数据取自进行该程序的NHS信托人和外科医生,所用手术技术(开放式,腹腔镜或机器人辅助)以及程序期间的住院时间。英国国家统计局的死亡率数据对该数据集进行了补充。研究了许多音量阈值和音量测量。多级建模用于调整层次结构和混杂因素。
结果:有18107例肾脏切除术和6762例膀胱癌切除术的数据可用。几乎没有证据表明信任或外科医生的人数会影响再入院率或死亡率。有证据表明,尽管大手术量和阈值很重要,但大手术量的医生可以缩短住院时间。
结论:我们发现几乎没有证据表明将肾切除术或膀胱切除术进一步集中用于癌症手术将改善所研究的患者预后。可能可以通过培训和支持较小容量的中心来优化住院时间,而不是进一步集中管理。

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