https://scholars.lib.ntu.edu.tw/handle/123456789/457154
標題: | Correlation Between the Increased Hospital Volume and Decreased Overall Perioperative Mortality in One Universal Health Care System | 作者: | JIN-MING WU Ho T.-W. YU-WEN TIEN |
公開日期: | 2019 | 出版社: | Springer New York LLC | 卷: | 43 | 期: | 9 | 起(迄)頁: | 2194-2202 | 來源出版物: | World Journal of Surgery | 摘要: | Background: Volume–outcome relationship has been demonstrated extensively for short-term outcomes for oncological surgery. However, its effect on long-term surgical outcomes or in one universal health care (UHC) system is unknown. This retrospective population-based study aims to validate the correlation between the increased hospital volume and better short- and long-term outcomes in patients who underwent total gastrectomy (TG) for gastric cancer. Methods: From the Taiwan National Health Insurance Research Database, we examined 7905 patients who underwent TG between 2000 and 2010. The surgical outcomes of this study were defined as death within 30, 60, and 180?days after TG. Results: A total of 7905 subjects were included for analysis. The mean age was 65.8?years, and 68.8% were males. The 30-, 60-, and 180-day mortality rates after TG for gastric cancer were 2.7%, 6.2%, and 18.2%, respectively. On the multivariate analysis, TG at high-volume hospitals significantly contributed to lower 30-day (odds ratio 0.64; 95% confidence interval 0.48–0.85; P < 0.001), 60-day (odds ratio 0.68; 95% confidence interval 0.56–0.82; P < 0.001), and 180-day mortality rates (odds ratio 0.80; 95% confidence interval 0.70–0.90; P < 0.001). Conclusions: Although TG is a complex operation with high mortality rates (~180-day), high hospital volume correlates with better perioperative outcomes even in UHC system. Hence, the strategy to advocate the centralization of TG is reasonable, especially for the elderly. ? 2019, Soci?t? Internationale de Chirurgie. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85067835779&doi=10.1007%2fs00268-019-05025-8&partnerID=40&md5=113802fbfd82507f27828d5ad538987f https://scholars.lib.ntu.edu.tw/handle/123456789/457154 |
ISSN: | 0364-2313 | DOI: | 10.1007/s00268-019-05025-8 | SDG/關鍵字: | aged; female; gastrectomy; high volume hospital; hospital mortality; human; male; middle aged; mortality; retrospective study; stomach tumor; Taiwan; very elderly; Aged; Aged, 80 and over; Female; Gastrectomy; Hospital Mortality; Hospitals, High-Volume; Humans; Male; Middle Aged; Retrospective Studies; Stomach Neoplasms; Taiwan; Universal Health Care |
顯示於: | 醫學系 |
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