Influence of hospital and clinician workload on survival from colorectal cancer: cohort study Commentary: How experienced should a colorectal surgeon be?
| Autor: | F Kee, R H Wilson, C Harper, C C Patterson, K McCallion, R F Houston, R J Moorehead, J M Sloan, B J Rowlands, R. Shields |
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| Rok vydání: | 1999 |
| Předmět: |
Clinical audit
medicine.medical_specialty Proportional hazards model business.industry General Engineering Cancer General Medicine Odds ratio medicine.disease Surgery Case mix index Median follow-up Emergency medicine medicine General Earth and Planetary Sciences business Survival analysis General Environmental Science Cohort study |
| Zdroj: | BMJ. 318:1381-1386 |
| ISSN: | 1468-5833 0959-8138 |
| Popis: | Objective: To determine whether clinician or hospital caseload affects mortality from colorectal cancer. Design: Cohort study of cases ascertained between 1990 and 1994 by a region-wide colorectal cancer register. Outcome measures: Mortality within a median follow up period of 54 months after diagnosis. Results: Of the 3217 new patients registered over the period, 1512 (48%) died before 31 December 1996. Strong predictors of survival both in a logistic regression (fixed follow up) and in a Cox9s proportional hazards model (variable follow up) were Duke9s stage, the degree of tumour differentiation, whether the liver was deemed clear of cancer by the surgeon at operation, and the type of intervention (elective or emergency and curative or palliative intent). In a multilevel model, surgeon9s caseload had no significant effect on mortality at 2 years. Hospital workload, however, had a significant impact on survival. The odds ratio for death within 2 years for cases managed in a hospital with a caseload of between 33 and 46 cases per year, 47 and 54 cases per year, and 55 cases per year (compared to one with ≤23 cases per year) were respectively 1.48 (95% confidence interval 1.03 to 2.13), 1.52 (1.08 to 2.13), and 1.18 (0.83 to 1.68). Conclusions: There was no detectable caseload effect for surgeons managing colorectal cancer, but survival of patients treated in hospitals with caseloads above 33 cases per year was slightly worse than for those treated in hospitals with fewer caseloads. Imprecise measurement of clinician specific “events rates” and the lack of routinely collected case mix data present major challenges for clinical audit and governance in the years ahead. |
| Databáze: | OpenAIRE |
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