709 OLDER AND SICKER RENAL CELL CARCINOMA PATIENTS ARE OPERATED AT LOW VOLUME HOSPITALS
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Résumé
You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2012709 OLDER AND SICKER RENAL CELL CARCINOMA PATIENTS ARE OPERATED AT LOW VOLUME HOSPITALS Maxine Sun, Quoc-Dien Trinh, Marco Bianchi, Jens Hansen, Nawar Hanna, Zhe Tian, Shahrokh Shariat, Paul Perrotte, and Pierre Karakiewicz Maxine SunMaxine Sun Montreal, Canada , Quoc-Dien TrinhQuoc-Dien Trinh Detroit, MI , Marco BianchiMarco Bianchi Milan, Italy , Jens HansenJens Hansen Hamburg, Germany , Nawar HannaNawar Hanna Montreal, Canada , Zhe TianZhe Tian Montreal, Canada , Shahrokh ShariatShahrokh Shariat New York, NY , Paul PerrottePaul Perrotte Montreal, Canada , and Pierre KarakiewiczPierre Karakiewicz Montreal, Canada View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.793AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hospital volume represents an established determinant of outcomes. We sought to examine the patient selection for surgical candidates according to hospital volume, using patient age and baseline comorbidities as proxies. METHODS Overall, 48172 non-metastatic renal cell carcinoma (RCC) patients were identified amongst 2084 hospitals originating from the Nationwide Inpatient Sample, between years 1998 and 2007. We examined patient age, baseline Charlson comorbidity index (CCI), gender, race, nephrectomy type, hospital teaching status, hospital region, and surgical approach (open vs. laparoscopic) according to hospital volume, which was modeled in a continuously coded fashion. Finally, we examined the effect of hospital volume on patient age and CCI, using linear regression analyses. Adjustment was made for all the aforementioned covariates. RESULTS The overall mean hospital volume was 16 nephrectomies per year (median 9, interquartile range [IQR]: 4–20). First, hospital volume decreased with increasing patient age (≤59 years mean: 17 (median 9) vs. ≥80 years: 13 (median 8), P<0.001) and increasing CCI (0 mean: 16 (median 9) vs. ≥3: 13 (median 8), P<0.001). The effect of hospital volume also differed according to gender, nephrectomy type, hospital teaching status, hospital region, and surgical approach. Specifically, females, patients of Hispanic race, radical nephrectomies, non-teaching hospitals, hospitals located in the West, and cases performed via the open approach were more likely to be of low hospital volume. In univariable linear regression analyses, decreasing age (beta: -0.044, P<0.001) and decreasing CCI (beta: -0.027, P<0.001) was inversely associated with increasing hospital volume. These findings were confirmed in multivariable analyses, where patients with increasing age (beta: -3.512, P<0.001) and higher CCI (beta: -3.896, P<0.001) were more likely to be operated at hospitals with a low hospital volume. CONCLUSIONS Individuals of more advanced age and those with multiple comorbidities tend to be treated at low hospital volume institutions. Such practice may lead to less favorable outcomes in those individuals. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e290-e291 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxine Sun Montreal, Canada More articles by this author Quoc-Dien Trinh Detroit, MI More articles by this author Marco Bianchi Milan, Italy More articles by this author Jens Hansen Hamburg, Germany More articles by this author Nawar Hanna Montreal, Canada More articles by this author Zhe Tian Montreal, Canada More articles by this author Shahrokh Shariat New York, NY More articles by this author Paul Perrotte Montreal, Canada More articles by this author Pierre Karakiewicz Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».