کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3984621 1601372 2015 9 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment
ترجمه فارسی عنوان
مقایسه نتایج سرطان روده بزرگ: تأثیر حجم کم پرونده بیمارستانی و تنظیم مورد-مخلوط
کلمات کلیدی
سرطان کولون، مرگ و میر نشت انستوموتیک، حجم کم پرونده بیمارستان، تنظیم مخلوط مورد
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی تومور شناسی
چکیده انگلیسی

ObjectiveWhen comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates.MethodsWe studied 13 120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment.ResultsAdding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise.ConclusionNoise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: European Journal of Surgical Oncology (EJSO) - Volume 41, Issue 8, August 2015, Pages 1045–1053
نویسندگان
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