Lee King-Teh, Chang Wen-Tseng, Huang Meng-Chuan, Chiu Herng-Chia
Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Dig Surg. 2004;21(5-6):406-12. doi: 10.1159/000082334. Epub 2004 Nov 24.
The volume-outcome effect has been well documented in both medical treatment and surgery. The relationship of volume-outcome utilization in laparoscopic cholecystectomy has not been studied. The aims of this study were to examine whether the operational volume of individual surgeons is associated with the clinical and economic outcomes of patients with gallbladder diseases undergoing laparoscopic cholecystectomy.
A retrospective study was made of all patients who underwent elective laparoscopic cholecystectomy in the Department of Surgery, Kaohsiung Medical University Hospital between January 1998 and April 2002. In total, 916 patients were operated on by 4 surgeons and the volume for each surgeon was 502, 192, 147, and 75 cases, respectively. Clinical and economic information for each patient was abstracted from medical charts and the financial division. Multiple logistic and linear regression models were used to examine the relationship between three outcome variables, complications, length of stay, total hospital charges, and surgeon volume while controlling for the severity of illness and other selected covariates (morbidity index).
Overall, a complication rate of 1.2% was identified. On average, the patient's stay in hospital was 4.7 days, and the average total hospital charge was TWD 49,581. After adjusting for covariates, three regression models indicated that the surgeon with the highest volume had the lowest complication rate, shortest length of stay, and lowest hospital charges.
The operative volume of individual surgeons not only had a positive impact on clinical outcomes, it also had greater effect on conservation of health care resources. The findings validate the theory of practice makes perfect.
手术量-预后效应在药物治疗和外科手术中均有充分记录。腹腔镜胆囊切除术中手术量-预后的关系尚未得到研究。本研究旨在探讨个体外科医生的手术量是否与接受腹腔镜胆囊切除术的胆囊疾病患者的临床及经济预后相关。
对1998年1月至2002年4月在高雄医学大学附属医院外科接受择期腹腔镜胆囊切除术的所有患者进行回顾性研究。共有916例患者由4位外科医生进行手术，每位医生的手术量分别为502例、192例、147例和75例。从病历和财务部门提取每位患者的临床及经济信息。在控制疾病严重程度和其他选定协变量（发病指数）的同时，使用多重逻辑回归和线性回归模型来检验三个预后变量（并发症、住院时间、总住院费用）与外科医生手术量之间的关系。
总体而言，并发症发生率为1.2%。患者平均住院时间为4.7天，平均总住院费用为新台币49,581元。在对协变量进行调整后，三个回归模型表明手术量最高的外科医生并发症发生率最低、住院时间最短且住院费用最低。
个体外科医生的手术量不仅对临床预后有积极影响，对医疗资源的节约也有更大作用。这些发现验证了熟能生巧的理论。
