일부 암 종의 수술량과 병원 내 사망률의 관계에서 구조적 복잡성의 조절효과

Abstract

Background: The volume of surgery has been examined as a major source of variation in outcome after surgery. This study investi-gated the direct effect of surgery volume to in hospitals mortality and the moderating effect of structural complexity-the level of diversity and sophistication of technology a hospital applied in patient care-to the volume outcome relationship. Methods: Discharge summary data of 11,827 cancer patients who underwent surgery and were discharged during a month period in 2010 and 2011 were analyzed. The analytic model included the independent variables such as surgery volume of a hospital, struc-tural complexity measured by the number of diagnosis a hospital examined, and their interaction term. This study used a hierarchi-cal logistic regression model to test for an association between hospital complexity and mortality rates and to test for the moderat-ing effect in the volume outcome relationship. Results: As structural complexity increased the probability of in-hospital mortality after cancer surgery reduced. The interaction term between surgery volume and structural complexity was also statistically significant. The interaction effect was the strongest among the patients group who had surgery in low volume hospitals. Conclusion: The structural complexity and volume of surgery should be considered simultaneously in studying volume outcome relationship and in developing policies that aim to reduce mortality after cancer surgery.