Jain Nitin, Pietrobon Ricardo, Guller Ulrich, Shankar Anoop, Ahluwalia Ajit S, Higgins Laurence D
Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC, USA.
Knee Surg Sports Traumatol Arthrosc. 2005 May;13(4):302-12. doi: 10.1007/s00167-004-0516-6. Epub 2004 Aug 4.
Operating-room time and patient disposition on discharge are important determinants of healthcare resource utilization and cost. We examined the relation between these determinants and hospital/surgeon volume for anterior cruciate ligament (ACL) reconstruction and meniscectomy procedures. Patients undergoing ACL reconstruction (18,390 cases) and meniscectomy (123,012 cases) were extracted from the State Ambulatory Surgery Databases for the years 1997-2000. Surgeon and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate logistic regression models were used to estimate the adjusted association between surgeon and hospital volume and patient discharge status and operating-room time. Patients undergoing ACL reconstruction or meniscectomy performed by low-volume surgeons were significantly more likely to be non-routinely discharged as compared to high-volume surgeons (adjusted odds ratio 3.5, 95% confidence interval 1.7-7.2 for ACL reconstruction; adjusted odds ratio 2.0, 95% confidence interval 1.6-2.3 for meniscectomy). The mean operating-room time for performing ACL reconstruction or meniscectomy was significantly higher in low- and intermediate-volume surgeons and hospitals as compared to high-volume surgeons and hospitals (p < or = 0.001). High-volume providers utilize healthcare resources more efficiently. Our findings may help surgeons and hospitals in optimizing resource utilization and cost for routinely-performed ambulatory surgery procedures.
手术室时间和出院时的患者处置情况是医疗资源利用和成本的重要决定因素。我们研究了这些决定因素与前交叉韧带（ACL）重建和半月板切除术的医院/外科医生手术量之间的关系。从1997 - 2000年的州门诊手术数据库中提取了接受ACL重建（18390例）和半月板切除术（123012例）的患者。外科医生和医院的手术量分为低、中、高手术量类别。使用多变量逻辑回归模型来估计外科医生和医院手术量与患者出院状态及手术室时间之间的校正关联。与高手术量的外科医生相比，由低手术量外科医生进行ACL重建或半月板切除术的患者非常规出院的可能性显著更高（ACL重建的校正比值比为3.5，95%置信区间为1.7 - 7.2；半月板切除术的校正比值比为2.0，95%置信区间为1.6 - 2.3）。与高手术量的外科医生和医院相比，低手术量和中等手术量的外科医生及医院进行ACL重建或半月板切除术的平均手术室时间显著更长（p≤0.001）。高手术量的医疗服务提供者能更有效地利用医疗资源。我们的研究结果可能有助于外科医生和医院优化常规门诊手术的资源利用和成本。
