Morton J M, Galanko J A, Soper N J, Low D E, Hunter J, Traverso L W
Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305-5655, USA.
Surg Endosc. 2006 Jul;20(7):1124-8. doi: 10.1007/s00464-004-8829-6. Epub 2006 May 13.
Surgical outcomes are increasingly examined in an effort to improve quality and reduce medical error. The Nationwide Inpatient Sample (NIS) is a retrospective, claims-derived and population-based database and the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Project is a prospective, voluntary and specialty surgeon database. We hypothesized that these two sources of outcome data would differ in regard to a single, commonly performed procedure.
Both the NIS, a national sample of all nonfederal hospital discharges, and the gastroesophageal reflux disease log of the SAGES Outcomes Project were queried for all fundoplications performed between 1999 and 2001 using either ICD-9 procedure code 44.66 or CPT codes 43280 or 43324. Patients with an emergency admission, age <17 years, and/or diagnoses for either esophageal cancer or achalasia were excluded. Both demographic and outcome variables were compared by either t-test or chi-square analysis, with a p value of <0.05 as significant.
Both data sets were comparable for age and gender; however, the SAGES group had a higher rate of teaching hospital affiliation (71 vs 48%, p < 0.001). SAGES fundoplications had a consistently higher rate of comorbidities, including Barrett's esophagus (2.3 vs 1.1%, p = 0.005). The NIS fundoplications had a clear trend toward more associated procedures, including cholecystectomy (7.2 vs 2%, p < 0.001). Complication rates for the NIS data set were higher, including pulmonary complications (1.7 vs 0.5%, p = 0.03). No statistically significant differences existed between the two data sets for either length of stay or mortality.
The two databases indicate that fundoplication is an operation with low morbidity and mortality. The SAGES Outcomes Project demonstrated that participating surgeons had a higher affiliation with teaching hospitals, higher reporting of comorbidity, and lower associated procedures than the NIS. Despite having more comorbidity and technical difficulty, patients from the SAGES Outcomes Project had equivalent or lower complication rates.
为提高医疗质量并减少医疗差错，人们越来越多地对手术结果进行研究。全国住院患者样本（NIS）是一个基于索赔数据的回顾性全国性数据库，而美国胃肠内镜外科医师协会（SAGES）的手术结果项目是一个前瞻性、自愿参与的专科外科医生数据库。我们推测，对于一项常见的手术，这两种手术结果数据来源会有所不同。
利用国际疾病分类第九版（ICD - 9）手术编码44.66或现行程序编码（CPT）43280或43324，对NIS（所有非联邦医院出院患者的全国样本）和SAGES手术结果项目的胃食管反流病记录进行查询，以获取1999年至2001年期间所有进行的胃底折叠术病例。排除急诊入院患者、年龄小于17岁的患者以及患有食管癌或贲门失弛缓症的患者。通过t检验或卡方分析比较人口统计学和手术结果变量，p值<0.05为有统计学意义。
两个数据集在年龄和性别方面具有可比性；然而，SAGES组与教学医院的关联率更高（71%对48%，p<0.001）。SAGES胃底折叠术患者的合并症发生率一直较高，包括巴雷特食管（2.3%对1.1%，p = 0.005）。NIS胃底折叠术患者进行更多相关手术的趋势明显，包括胆囊切除术（7.2%对2%，p<0.001）。NIS数据集的并发症发生率更高，包括肺部并发症（1.7%对0.5%，p = 0.03）。两个数据集在住院时间或死亡率方面均无统计学显著差异。
这两个数据库表明，胃底折叠术是一种发病率和死亡率较低的手术。SAGES手术结果项目显示参与的外科医生与教学医院的关联度更高，合并症报告率更高，相关手术比NIS少。尽管SAGES手术结果项目的患者合并症更多且技术难度更大，但其并发症发生率相当或更低。
