Abstract
BackgroundLittle is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume.MethodsWe analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR) and nurse-to-bed ratio (NBR) were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR) was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume.ResultsOverall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds) and high NBR (≥77.0 nurses per 100 beds) was significantly lower than that in the group with low PBR (<19.7) and low NBR (<77.0) (9.2% vs. 14.5%; odds ratio, 0.76; 95% confidence interval, 0.68–0.86; p < 0.001).ConclusionsWell-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.
Highlights
Little is known about the effects of professional staffing on cancer surgical outcomes
Previous studies have suggested that professional staffing is associated with better short-term outcomes, including physician staffing [10,11,12] and nurse staffing [13,14,15]
The median Physician-to-bed ratio (PBR) was 19.7 per 100 beds and the median nurse-to-bed ratio (NBR) was 77.0 (68.2–86.1) per 100 beds. These numbers were used as cutoff points to categorize physician/nurse staffing into four categories
Summary
Little is known about the effects of professional staffing on cancer surgical outcomes. Japan is unique in that the numbers of physician/ nurses per bed are extremely low compared with Western standards; there are 26.5 physicians and 117.8 nurses per 100 beds in Japan, while there are 96.1 and 268.1, respectively, in Organization for Economic Cooperation and Development countries [16] This situation has been created by an excess in the number of hospitals and beds. With regard to physician staffing, only the minimum standard (at least 1 physician per 16 acute care beds in Medical Service Law) is set without further incentives to raise the physician-to-bed ratio, which varies widely between hospitals. Under such an extremely low end of staffing, improvement of professional staffing remains an important policy issue in Japan [17]
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