Impact of Procedure Volumes and Focused Practice on Short-Term Outcomes of Elective and Urgent Colon Cancer Resection in ItalyReportar como inadecuado




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Background

The relationship between hospital volumes and short-term patients’ outcomes of colon cancer CC surgery is not well established in the literature. Moreover, evidence about short-term outcomes of urgent compared with elective CC procedures is scanty. The aims of this study are 1 to determine whether caseloads and other hospital characteristics are associated with short-term outcomes of CC surgery; 2 to compare the outcomes of urgent and elective CC surgery.

Methods

A total of 14,200 patients undergoing CC surgery between 2005 and 2010 in the General Surgery Units GSUs of the hospitals of Emilia-Romagna region, Northern Italy, were identified from the hospital discharge records database. The outcomes of interest were 30-day in-hospital mortality, re-intervention and 30-day re-admission. Using multilevel analysis, we analyzed the relationship of GSU volumes and focused practice, defined as the percentage of CC operations over total operations, with the three outcomes.

Results

High procedure volumes were associated with a lower risk of 30-day in-hospital mortality, after adjusting for patients’ characteristics aOR 95% CI = 0.51 0.33–0.81. Stratified analyses for elective and urgent surgery showed that high volumes were associated with a lower 30-day mortality for elective patients aOR 95% CI = 0.35 0.17–0.71, but not for urgent patients aOR 95% CI = 0.72 0.42–1.24. Focused practice was an independent predictor of re-intervention aOR 95% CI = 0.67 0.47–0.97 and re-admission aRR 95% CI = 0.88 0.78–0.98.

Conclusions

The present study adds evidence in support of the notion that patients with CC undergoing surgery at high-volume and focused surgical units experience better short-term outcomes.



Autor: Jacopo Lenzi, Raffaele Lombardi, Davide Gori, Nicola Zanini, Dario Tedesco, Michele Masetti, Elio Jovine, Maria Pia Fantini

Fuente: http://plos.srce.hr/



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