Blatier J F, Fauconnier J
Assurance Maladie des Professions Indépendantes, Service Médical, Caisse Maladie Régionale des Alpes, 2, avenue de l'Obiou, 38706 La Tronche Cedex, France.
Rev Epidemiol Sante Publique. 2001 Apr;49(2):173-82.
Comparisons between hospitals using surgical volume, among other criteria can be made using large hospital databases. A relationship between hospital volume and care results, particularly mortality, is assumed to justify the use of activity volume as a comparison criterion. We aimed to assess a relationship between hospital volume and mortality after total hip replacement using the data available in the French Diagnosis Related Groups (Programme de Médicalisation des Systèmes d'Information, PMSI). We also searched for a threshold associated with mortality.
We included all stays with a surgical procedure for total hip replacement in public hospitals in the Rhône-Alpes region in France in 1997 (n=5521). We examined the relationship between mortality and the number of procedures per hospital and assessed activity threshold using logistic regression.
Using the number of procedures as the continuous variable, we observed a relationship with mortality (OR=0.94 [0.91; 0.96] for an increase in activity of 100 total hip replacements). We found no evidence of an activity threshold. The reason for performing total hip replacement (OR=6.36 [2.78; 14.55] for trauma compared with rheumatology diseases) and patient age (OR=1.76 [1.31; 2.36] for a 10-year increase in age) were strongly related to mortality.
PMSI only collects in-hospital mortality, limiting the impact of our findings. The relationship between mortality and hospital volume is significant, but too small and consequently of little use. We found no activity threshold. It would be difficult to recommend surgical volume as a criterion for comparing hospitals.
利用大型医院数据库，可以依据手术量等标准对医院进行比较。人们认为医院手术量与医疗结果，尤其是死亡率之间存在关联，这证明将手术量作为比较标准是合理的。我们旨在利用法国诊断相关分组（信息系统医疗化计划，PMSI）中的现有数据，评估全髋关节置换术后医院手术量与死亡率之间的关系。我们还探寻了与死亡率相关的阈值。
我们纳入了1997年法国罗纳-阿尔卑斯地区公立医院所有进行全髋关节置换手术的住院病例（n = 5521）。我们研究了死亡率与每家医院手术例数之间的关系，并使用逻辑回归评估手术量阈值。
将手术例数作为连续变量，我们观察到其与死亡率存在关联（全髋关节置换手术量每增加100例，比值比[OR]=0.94[0.91; 0.96]）。我们没有发现手术量阈值的证据。进行全髋关节置换手术的原因（创伤与风湿性疾病相比，OR = 6.36[2.78; 14.55]）和患者年龄（年龄每增加10岁，OR = 1.76[1.31; 2.36]）与死亡率密切相关。
PMSI仅收集院内死亡率，这限制了我们研究结果的影响。死亡率与医院手术量之间的关系显著，但影响过小，因此作用不大。我们没有发现手术量阈值。很难推荐将手术量作为比较医院的标准。
