Influence of a regional centralised upper gastrointestinal cancer service model on patient safety, quality of care and survival

摘要

Aims: The aim of this study was to determine outcomes of a reconfigured centralised upper gastrointestinal (UGI) cancer service model, allied to an enhanced recovery programme, when compared with historical controls in a UK cancer network. Materials and methods: Details of 606 consecutive patients diagnosed with UGI cancer were collected prospectively and outcomes before ( n=251) and after ( n=355) centralisation compared. Primary outcome measures were rates of curative treatment intent, operative morbidity, length of hospital stay and survival. Results: The rate of curative treatment intent increased from 21 to 36% after centralisation ( P<0.0001). Operative morbidity (mortality) and length of hospital stay before and after centralisation were 40% (2.5%) and 16 days, compared with 45% (2.4%) and 13 days, respectively ( P=0.024). The median and 1 year survival (all patients) improved from 8.7 months and 39.0% to 10.8 months and 46.8%, respectively, after centralisation ( P=0.032). On multivariate analysis, age (hazard ratio 1.894, 95% confidence interval 0.743-4.781, P<0.0001), centralisation (hazard ratio 0.809, 95% confidence interval 0.668-0.979, P=0.03) and overall radiological TNM stage (hazard ratio 3.905, 95% confidence interval 1.413-11.270, P<0.0001) were independently associated with survival. Conclusion: These outcomes confirm the patient safety, quality of care and survival improvements achievable by compliance with National Health Service Improving Outcomes Guidance.