PDF(Pubmed)
Abstract：
BACKGROUND: Postoperative mortality plays an important role in evaluating the surgical safety of esophagectomy. Although postoperative mortality after esophagectomy is partly influenced by the yearly hospital surgical case volume (hospital volume), this association remains unclear.
METHODS: Studies assessing the association between hospital volume and postoperative mortality in patients who underwent esophagectomy for esophageal cancer were searched for eligibility. Odds ratios were pooled for the highest versus lowest categories of hospital volume using a random effects model. The dose-response association between hospital volume and the risk of postoperative mortality was analyzed. The study protocol was registered with PROSPERO.
RESULTS: Fifty-six studies including 385 469 participants were included. A higher-volume hospital significantly reduced the risk of postesophagectomy mortality by 53% compared with their lower-volume counterparts (odds ratio, 0.47; 95% CI: 0.42-0.53). Similar results were found in subgroup analyses. Volume-outcome analysis suggested that postesophagectomy mortality rates remained roughly stable after the hospital volume reached a plateau of 45 esophagectomies per year.
CONCLUSIONS: Higher-volume hospitals had significantly lower postesophagectomy mortality rates in patients with esophageal cancer, with a threshold of 45 esophagectomies per year for a high-volume hospital. This remarkable negative correlation showed the benefit of a better safety in centralization of esophagectomy to a high-volume hospital.
METHODS: Studies assessing the association between hospital volume and postoperative mortality in patients who underwent esophagectomy for esophageal cancer were searched for eligibility. Odds ratios were pooled for the highest versus lowest categories of hospital volume using a random effects model. The dose-response association between hospital volume and the risk of postoperative mortality was analyzed. The study protocol was registered with PROSPERO.
RESULTS: Fifty-six studies including 385 469 participants were included. A higher-volume hospital significantly reduced the risk of postesophagectomy mortality by 53% compared with their lower-volume counterparts (odds ratio, 0.47; 95% CI: 0.42-0.53). Similar results were found in subgroup analyses. Volume-outcome analysis suggested that postesophagectomy mortality rates remained roughly stable after the hospital volume reached a plateau of 45 esophagectomies per year.
CONCLUSIONS: Higher-volume hospitals had significantly lower postesophagectomy mortality rates in patients with esophageal cancer, with a threshold of 45 esophagectomies per year for a high-volume hospital. This remarkable negative correlation showed the benefit of a better safety in centralization of esophagectomy to a high-volume hospital.
摘要：
背景：术后死亡率在评估食管癌切除术的手术安全性方面起着重要作用。尽管食管切除术后的死亡率部分受到每年医院手术病例量（医院量）的影响，这种联系尚不清楚。
方法：在评估因食管癌而接受食管切除术的患者的住院人数与术后死亡率之间的相关性的研究中，我们进行了筛选。使用随机效应模型将最高和最低医院容量类别的赔率比汇总。分析了医院容量与术后死亡风险之间的剂量反应关系。研究方案在PROSPERO注册。
结果：纳入56项研究，包括385.469名参与者。与低容量的医院相比，高容量的医院将食管癌切除术后死亡率的风险显着降低了53％（优势比，0.47；95%CI：0.42-0.53）。在亚组分析中发现了类似的结果。体积结果分析表明，在医院体积达到每年45例食管切除术的平台后，食管切除术后的死亡率大致保持稳定。
结论：在食道癌患者中，规模较大的医院具有显著较低的食道切除术后死亡率，对于一家高容量医院，每年进行45例食管切除术的门槛。这种显着的负相关表明，将食管切除术集中到高容量医院具有更好的安全性。
方法：在评估因食管癌而接受食管切除术的患者的住院人数与术后死亡率之间的相关性的研究中，我们进行了筛选。使用随机效应模型将最高和最低医院容量类别的赔率比汇总。分析了医院容量与术后死亡风险之间的剂量反应关系。研究方案在PROSPERO注册。
结果：纳入56项研究，包括385.469名参与者。与低容量的医院相比，高容量的医院将食管癌切除术后死亡率的风险显着降低了53％（优势比，0.47；95%CI：0.42-0.53）。在亚组分析中发现了类似的结果。体积结果分析表明，在医院体积达到每年45例食管切除术的平台后，食管切除术后的死亡率大致保持稳定。
结论：在食道癌患者中，规模较大的医院具有显著较低的食道切除术后死亡率，对于一家高容量医院，每年进行45例食管切除术的门槛。这种显着的负相关表明，将食管切除术集中到高容量医院具有更好的安全性。
