Jain Nitin B, Pietrobon Ricardo, Guller Ulrich, Ahluwalia Ajit S, Higgins Laurence D
Center for Excellence in Surgical Outcomes, Durham, NC, USA.
J Shoulder Elbow Surg. 2005 Jul-Aug;14(4):407-13. doi: 10.1016/j.jse.2004.09.003.
Length of hospital stay, operating room time, and disposition of patient on discharge are important determinants of health care resource utilization. We examined the relationship between these determinants and hospital/surgeon volume for rotator cuff repair. A total of 9,973 patients undergoing rotator cuff repair were extracted from the New York State Ambulatory Surgery Databases for the years 1997 through 2000. Surgeon volume and hospital volume were divided into low-, intermediate-, and high-volume categories. Multivariate regression models were used to estimate the risk-adjusted association between provider volume and outcomes. Patients operated on by low-volume surgeons had significantly higher likelihood for an extended length of stay when compared with those operated on by high-volume surgeons (adjusted odds ratio for extended length of stay, 2.3; 95% confidence interval, 1.2-4.4). There was a linear trend for a higher proportion of routine patient discharge with increasing surgeon volume. The mean operating room times for low- and intermediate-volume surgeons were significantly higher than that for high-volume surgeons (P < .001). We conclude that high-volume providers use health care resources more efficiently.
住院时间、手术室时间以及患者出院时的处置情况是医疗资源利用的重要决定因素。我们研究了这些决定因素与肩袖修复手术的医院/外科医生手术量之间的关系。从1997年至2000年的纽约州门诊手术数据库中提取了总共9973例行肩袖修复手术的患者。外科医生手术量和医院手术量被分为低、中、高手术量类别。使用多变量回归模型来估计医疗服务提供者手术量与结果之间经风险调整后的关联。与高手术量外科医生手术的患者相比，低手术量外科医生手术的患者住院时间延长的可能性显著更高（住院时间延长的调整优势比为2.3；95%置信区间为1.2 - 4.4）。随着外科医生手术量的增加，常规患者出院比例呈线性上升趋势。低手术量和中等手术量外科医生的平均手术室时间显著高于高手术量外科医生（P < .001）。我们得出结论，高手术量的医疗服务提供者能更有效地利用医疗资源。
