目的:评估过去15年在法国接受肺癌手术的患者的质量指标(30天死亡率和抢救失败)的演变,并研究潜在的影响因素。
方法:使用来自法国医院数据库(PMSI)的数据进行回顾性队列研究。
方法:全国人群研究。
方法:所有在法国(2005-2020)接受肺癌肺切除术的患者(N=157566)。患者特征(年龄、性别,合并症),手术(手术方法,切除类型,切除范围)和医院(医院类型,肺切除术的医院容积)被取回。
方法:我们研究了两个结局指标:30天死亡率和抢救失败。我们使用基于回归的技术(包括中断的时间序列)来评估患者和医院特征对30天死亡率和抢救失败的影响(30天内至少有一个主要术后并发症的患者的死亡人数术后)。调整案例组合。
结果:30天死亡率从2005年的3.8%上升到2010年的4.9%,然后下降到2020年的2.9%。救援失败率从2005年的12.2%下降到2020年的7.1%。随着时间的推移,肺切除术率显着下降(2005年为18.1%,2020年为4.8%),并且在两个时期(2005-2010/2015-2020)之间对死亡率降低的贡献最大。使用电视胸腔镜手术或机器人辅助手术对降低两个时期的死亡率(观察到的死亡率差异的16%)有很大的影响,医院数量也是如此。
结论:手术实践的变化,特别是肺切除术的减少,可能是2011年以来法国术后死亡率降低和抢救失败的主要原因之一。医院数量是降低术后死亡率的另一个重要因素。我们的研究应该鼓励使用技术或组织创新,例如手术实践和癌症手术授权的变化,提高护理质量。
To estimate the evolution of quality indicators (30-day mortality and failure-to-rescue) inpatients who underwent lung cancer surgery in France over the past 15 years and to
study the potential influencing factors.
Retrospective cohort
study using data from the French hospital database (PMSI).
Nationwide population-based
study.
All patients who underwent pulmonary resection for lung cancer in France (2005-2020) were included (N=1 57 566). Characteristics of patients (age, gender, comorbidities), surgery (surgical approach, type of resection, extent of resection) and hospital (type of hospital, hospital volume for pulmonary resections) were retrieved.
We studied two outcome indicators: 30-day mortality and failure-to-rescue. We used regression-based techniques (including interrupted time-series) to assess the effects of patient and hospital characteristics on 30-day mortality and failure-to-rescue (number of deaths among patients with at least one major postoperative complication within the 30 days after surgery), adjusting for case mix.
The 30-day mortality rate increased from 3.8% in 2005 to 4.9% in 2010 and then decreased to 2.9% in 2020. The failure-to-rescue rate decreased from 12.2% in 2005 to 7.1% in 2020. The pneumonectomy rate decreased significantly over time (18.1% in 2005 to 4.8% in 2020) and had the greatest contribution on the reduction of mortality between two periods (2005-2010/2015-2020). The use of video-assisted thoracoscopic surgery or robot-assisted surgery had a great influence on the reduction of mortality (16% of the observed difference in mortality) between the two periods, as did hospital volume.
The change in surgical practices, particularly the reduction in pneumonectomies, could be one of the main reasons for reduction in postoperative mortality and failure-to-rescue in France since 2011. Hospital volume is another important factor in reducing postoperative mortality. Our
study should encourage the use of technological or organisational innovation, such as changes in surgical practice and cancer surgery authorisations, to improve quality of care.