Subespecialización y calidad asistencial en la cirugía de las resecciones hepáticas

Grande, Luis

doi:10.1016/s0009-739x(05)70876-9

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…For some of the types of cancer studied this 6-month follow-up may be a fairly short period for the assessment of outcomes, but it represents a significant advancement over the majority of studies that limit their analyses to the in-hospital period, especially those based on hospital discharge MBDS. 4 …”

Section: Discussionmentioning

confidence: 99%

“…However, this relationship is not always observed, and the reasons why it occurs remain unknown. Several hypotheses, especially relating to surgeon-related technical factors (2)(3)(4)(5)(6), have been considered. However, if better outcomes are obtained in several different procedures or pathologies, healthcare organization and coordination factors should also be sought.…”

Section: Introductionmentioning

confidence: 99%

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Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Espallargues

Almazán

Tebé

et al. 2009

Rev. esp. enferm. dig.

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Background: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume.Objective: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations.Patients and method: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and followup mortality, complications, re-interventions, and relapse rates.Results: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 patients (98%) were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months), were identified.Conclusions: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.Key words: Digestive cancer. Surgery. Medical practice variations. Structure, process, and outcomes of care. INTRODUCTIONOne of the aspects that is most debated in oncologic surgery and other fields (both surgical and medical procedures) is the relationship between the volume of patients having undergone surgery and clinical outcomes. It has been 30 years since the relationship between increased volume and improved outcomes was described (1). However, this relationship is not always observed, and the reasons why it occurs remain unknown. Several hypotheses, especially relating to surgeon-related technical factors (2-6), have been considered. However, if better outcomes are obtained in several different procedures or pathologies, healthcare organization and coordination factors should also be sought. This may be especially useful in the case of oncology, where it is necessary for professionals from different specialties to work together in tackling with diagnosis and treatment: surgery, oncology, as well as the site's central and general services.Most studies that have analyzed the influence of these physician-/center-related factors, particularly volume, on the variability of the process and outcome of cancer surgery are retrosp...

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Section: Discussionmentioning

confidence: 99%