BACKGROUND The relationship of volume and travel distance to patient outcomes after resection of gallbladder cancer (GBC) remains poorly defined. METHODS The 2004-2015 National Cancer Database was used to identify GBC resection patients and examine the impact of travel distance, hospital volume and both on overall survival (OS) and quality of care indicators. RESULTS Among 10,174 patients undergoing surgery for GBC, the majority of patients were Caucasian (N = 8,175, 80%) and had a Charlson-Deyo comorbidity score of 0 (N = 6,785, 67%). On unadjusted survival analysis increasing travel distance and hospital volume were associated with improved OS (both p < 0.001). After controlling for competing risk factors, the 4th quartile of hospital volume was associated with a decreased hazard of death (HR 0.831, 95% CI 0.751-0.920, p < 0.001). When both hospital volume and travel distance were included, the association with improved OS persisted only for hospital volume (4th quartile HR 0.835, 95% CI 0.753-0.925, p < 0.001), whereas there was no independent association of increasing travel distance with OS. CONCLUSIONS Both increasing travel distance and hospital volume were associated with improved OS; however, adjusted models demonstrated that the impact of travel distance was mediated through hospital volume.

中文翻译：

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前往大容量医院接受胆囊癌切除术：这是否会影响护理质量和长期结果？

背景技术胆囊癌（GBC）切除后，容积和行进距离与患者预后的关系仍然不清楚。方法2004-2015年国家癌症数据库用于鉴定GBC切除患者，并检查出行距离，医院数量以及总体生存率（OS）和护理质量指标的影响。结果在接受GBC手术的10,174例患者中，大多数患者为白种人（N = 8,175，80％），Charlson-Deyo合并症得分为0（N = 6,785，67％）。在未经调整的生存分析中，旅行距离的增加和医院容量的增加与OS的改善相关（均p <0.001）。在控制了竞争性危险因素后，医院数量的第4个四分位数与死亡风险降低相关（HR 0.831，95％CI 0.751-0.920，p <0.001）。当包括住院量和出行距离时，仅在住院量方面与OS改善的相关性持续存在（第四四分位HR 0.835，95％CI 0.753-0.925，p <0.001），而行进距离增加与OS之间没有独立的关联。结论出行距离的增加和医院容量的增加均与OS的改善有关。然而，调整后的模型表明，出行距离的影响是通过医院数量来介导的。