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Regionalization, Readmissions, and Repercussions of Major Cancer Surgery
JAMA Surgery ( IF 16.9 ) Pub Date : 2018-08-01 , DOI: 10.1001/jamasurg.2018.0403
Srinivas J. Ivatury 1, 2 , Sandra L. Wong 1, 2
Affiliation  

Longstanding data noting the volume-outcomes relationship in high-risk surgical procedures has led to ongoing work to realize the implied benefits.1,2 Two main strategies are considered: regionalization to high-volume centers and translation of best practices from high-volume centers to improve care across settings. Resultant increased travel distances from regionalization—an inconvenience when arriving for surgery—presents complex problems for patients at discharge that are magnified if complications occur. As Zafar et al3 found in their work, the benefits of regionalization are tempered because readmissions to local (nonindex) hospitals after major cancer surgery are associated with significantly higher risks of mortality and morbidity. The unintended consequences of regionalization warrant consideration.



中文翻译:

大型癌症手术的区域划分,再入院率和影响

长期数据表明高风险手术过程中的数量与结果之间的关系,导致人们正在进行持续的工作以实现隐含的收益。1 ,2两个主要策略考虑:从大批量中心区域化大批量中心和最佳实践的翻译在不同环境下,以提高医疗质量。因区域化而导致的旅行距离增加(到达手术时的不便)给出院患者带来了复杂的问题,如果发生并发症,这些问题会被放大。正如Zafar等人3在他们的工作中发现,区域化的好处受到了削弱,因为大型癌症手术后再次进入当地(非索引)医院会带来更高的死亡率和发病率风险。区域化的意外后果值得考虑。

更新日期:2018-08-15
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