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作者：SCI天天读
SCI
20 June 2023
Surgeon Quality and Patient Survival After Resection for Non–Small-Cell Lung Cancer
(IF: JCO., 50.717)
Ray MA, Akinbobola O, Fehnel C, Saulsberry A, Dortch K, Wolf B, Valaulikar G, Patel HD, Ng T, Robbins T, Smeltzer MP, Faris NR, Osarogiagbon RU; Mid-South Quality of Surgical Resection (MS-QSR) Consortium. Surgeon Quality and Patient Survival After Resection for Non-Small-Cell Lung Cancer. J Clin Oncol. 2023 Jun 2:JCO2201971. doi: 10.1200/JCO.22.01971. Epub ahead of print. PMID: 37267506.
Purpose 目的
The quality and outcomes of curative-intent lung cancer surgery vary in populations. Surgeons are key drivers of surgical quality. We examined the association between surgeon-level intermediate outcomes differences, patient survival differences, and potential mitigation by processes of care.
根治性肺癌手术质量和预后因人群而异。外科医生是手术质量的关键驱动因素。我们研究了手术医生水平的中间结果差异、患者生存差异以及护理过程潜在缓解作用之间的关联。
Patients and Methods 患者与方法
Using a baseline population-based surgical resection cohort, we derived surgeon-level cut points for rates of positive margins, nonexamination of lymph nodes, nonexamination of mediastinal lymph nodes, and wedge resections. Applying the baseline cut points to a subsequent cohort from the same population-based data set, we assign surgeons into three performance categories in reference to each metric: 1 (<25th percentile), 2 (25th-75th percentile), and 3 (>75th percentile). The sum of performance scores created three surgeon quality tiers: 1 (4-6, low), 2 (7-9, intermediate), and 3 (10-12, high). We used chi-squared, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests to compare patient characteristics between the baseline and subsequent cohorts and across surgeon tiers. We applied Cox proportional hazards models to examine the association between patient survival and surgeon performance tier, sequentially adjusting for clinical stage, patient characteristics, and four specific processes.
使用基于基线人群的外科手术切除队列，我们得出了阳性切缘率、淋巴结未检查率、纵隔淋巴结未检查率和楔形切除率的外科医生水平切点。将基线切点应用于同一基于人群的数据集的后续队列，我们将外科医生分成三个绩效水平类别，具体参照了每个指标: 1 (<25%), 2 (25-75%) 和 3 (>75%)。绩效得分的总和产生了三个外科医生质量等级：1（4-6，低），2（7-9，中等）和3（10-12，高）。我们使用卡方检验、Wilcoxon-Mann-Whitney检验和Kruskal-Wallis检验来比较基线和后续队列之间、以及外科医生不同级别之间的患者特征。我们采用Cox比例风险模型，依次调整临床分期、患者特征和四个特定过程，以研究患者存活率与外科医生绩效等级之间的关联。
Results 结果
From 2009 to 2021, 39 surgeons performed 4,082 resections across the baseline and subsequent cohorts. Among 31 subsequent cohort surgeons, five were tier 1, five were tier 2, and 21 were tier 3. Tier 1 and 2 surgeons had significantly worse outcomes than tier 3 surgeons (hazard ratio [HR], 1.37; 95% CI, 1.10 to 1.72 and 1.19; 95% CI, 1.00 to 1.43, respectively). Adjustment for specific processes mitigated the surgeon-tiered survival differences, with adjusted HRs of 1.02 (95% CI, 0.8 to 1.3) and 0.93 (95% CI, 0.7 to 1.25), respectively.
从2009年到2021年，共有39名外科医生在基线和后续队列中进行了4082例手术切除。在随后的31名队列的外科医生中，5名为1级，5名为2级，21名为3级。1级和2级的外科医生的预后明显比3级的外科医生差（分别为：风险比[HR] 1.37; 95% CI，1.10至1.72和1.19; 95% CI，1.00至1.43）。针对特定过程的调整减轻了外科医生分级的生存差异，调整后的HR分别为1.02（95% CI，0.8至1.3）和0.93（95% CI，0.7至1.25）。
Conclusion 结论
Readily accessible intermediate outcomes metrics can be used to stratify surgeon performance for targeted process improvement, potentially reducing patient survival disparities.
易于获取的中间结果指标可以用于对外科医生的绩效进行分层，以进行有针对性的过程改进，从而有可能减少患者的生存差异。
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链接：https://pan.baidu.com/s/1iL1gjoCM-g08u0fWRz-AeQ
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原文地址：http://mp.weixin.qq.com/s?src=11×tamp=1687317334&ver=4603&signature=FzNIYu1FUnDhbD61CNkVfOwRqBIiUP1CdM592dOUp1WqGZJAhpUmHcBDbVVblXUvote9KRXtoEFbgU3Hgh2gphO*ed4AiiX6USR3JCaBUSV9w4bfPiiNtmssPb8LilQd&new=1 |
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