Irita Kazuo, Kawashima Yasuo, Tsuzaki Koichi, Iwao Yasuhide, Seo Norimasa, Morita Kiyoshi, Sawa Tomohiro, Sanuki Michiyoshi, Makita Koshi, Kobayashi Yoshirou, Obara Hidefumi, Oomura Akito
Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582.
Masui. 2004 Dec;53(12):1421-8.
We have previously showed that surgical volume affects mortality due to intraoperative critical incidents among patients undergoing cardiac surgery, the surgery with the highest risk, using data obtained by the annual survey in 2001 conducted by the Japanese Society of Anesthesiologists (JSA). In this study, we investigated whether surgical volume affects mortality due to intraoperative critical incidents independent of the surgical site.
We investigated this relationship using data obtained from the 2002 annual survey conducted by the Subcommittee on Surveillance of Anesthesia-related Critical Incidents, JSA. Between January 1, 2002 and December 31, 2002, 1,987,988 patients were registered from 704 training hospitals certified by the JSA. Intraoperative critical incidents occurred in 2,844 patients. Of these, 804 patients died within 7 postoperative days. The overall mortality was 4.61 per 10,000 anesthetics. Hospitals were divided into 5 groups according to their annual surgical cases: Group A, fewer than 1,000 (62 hospitals); Group B, 1,000-1,999 (204 hospitals); Group C, 2,000-3,999 (288 hospitals); Group D, 4,000-5,999 (110 hospitals); Group E, more than 6,000 (40 hospitals). Hospitals were also divided into 2 groups according to mortality: Group 1, under 20.00 per 10,000 anesthetics (672 hospitals); Group 2, equal to or higher than 20.00 per 10,000 anesthetics (32 hospitals). Total number of deaths in Group 2 was 158. Mortality was expressed as the mean (95% confidence interval). Statistical analysis was performed using chi-square test and Fisher test. A p value of <0.05 was considered significant.
The mortality rates in Groups A-E were 14.89 (8.48-21.3), 3.86 (3.05-4.67), 3.88 (3.19-4.57), 4.04 (3.20-4.88), and 3.12 (2.19-4.05) per 10,000 anesthetics, respectively. Average surgical cases and mortality in Group 1 were 2,789 (2,775-3,002) and 3.24 (2.90-3.58), respectively, while those in Group 2 were 1,672 (1,243-2,101) and 22.18 (30.58-45.94), respectively. If all patients in Group 2 (n=53,509) had been treated in the hospitals of Group 1, 139-143 deaths might have been avoided.
Surgical volume was shown to affect mortality independent of the surgical site. Hospitals with low surgical volume should pay significant attention to improving surgical outcomes. These results also suggest that centralization or regionalization should be discussed from the perspective of socio-economical problems as well as patient safety.
我们之前利用日本麻醉医师协会（JSA）2001年年度调查所获数据表明，手术量会影响心脏手术（风险最高的手术）患者术中严重事件导致的死亡率。在本研究中，我们调查了手术量是否会独立于手术部位影响术中严重事件导致的死亡率。
我们利用JSA麻醉相关严重事件监测小组委员会2002年年度调查所获数据来研究这种关系。在2002年1月1日至2002年12月31日期间，来自JSA认证的704家培训医院的1,987,988例患者进行了登记。2,844例患者发生了术中严重事件。其中，804例患者在术后7天内死亡。总体死亡率为每10,000例麻醉4.61例。医院根据其年度手术病例数分为5组：A组，少于1000例（62家医院）；B组，1000 - 1999例（204家医院）；C组，2000 - 3999例（288家医院）；D组，4000 - 5999例（110家医院）；E组，超过6000例（40家医院）。医院还根据死亡率分为2组：1组，每10,000例麻醉低于20.00例（672家医院）；2组，每10,000例麻醉等于或高于20.00例（32家医院）。2组的死亡总数为158例。死亡率以均值（95%置信区间）表示。采用卡方检验和Fisher检验进行统计分析。p值<0.05被认为具有统计学意义。
A - E组每10,000例麻醉的死亡率分别为14.89（8.48 - 21.3）、3.86（3.05 - 4.67）、3.88（3.19 - 4.57）、4.04（3.20 - 4.88）和3.12（2.19 - 4.05）。1组的平均手术病例数和死亡率分别为2,789（2,775 - 3,002）和3.24（2.90 - 3.58），而2组分别为1,672（1,243 - 2,101）和22.18（30.58 - 45.94）。如果2组的所有患者（n = 53,509）都在1组的医院接受治疗，可能可避免139 - 143例死亡。
结果表明手术量会独立于手术部位影响死亡率。手术量低的医院应高度重视改善手术结果。这些结果还表明，应从社会经济问题以及患者安全的角度讨论集中化或区域化问题。
