Stavrakis Alexandra I, Ituarte Philip H G, Ko Clifford Y, Yeh Michael W
Endocrine Surgical Unit and Center for Surgical Outcomes and Quality, VA Greater Los Angeles Healthcare System, Los Angeles, Calif., USA.
Surgery. 2007 Dec;142(6):887-99; discussion 887-99. doi: 10.1016/j.surg.2007.09.003. Epub 2007 Oct 26.
Surgeon experience correlates with improved outcomes for complex operations. Endocrine operations are increasingly performed in the outpatient setting, where outcomes have not been systematically studied. We examined the effect of surgeon volume on clinical and economic outcomes for thyroid, parathyroid, and adrenal surgery across inpatient and outpatient settings.
New York and Florida state discharge data (2002) were studied. Surgeons were grouped by annual endocrine operative volume: Group A, 1 to 3 operations; B, 4 to 8; C, 9 to 19; D, 20 to 50; E, 51 to 99; and F, >or=100. Multiple regression analyses were applied to analyze complications, length of stay (LOS), and total charges (TC), while controlling for comorbidity, economic factors, and hospital-centric variables.
We identified 13,997 discharges, with 28% of operations performed on an outpatient basis (admission/discharge on same calendar day). For all cases, group A contributed disproportionately more complications (observed/expected [O/E] 1.65, P < .001) and Group F contributed disproportionately less (0.52; P < .001). High surgeon volume was associated with decreased LOS and reduced TC. Hospital volume had a negligible effect on outcomes.
Surgeon volume correlates inversely with complication rates, LOS, and TC, in endocrine surgery. The lowest complication rates are achieved by surgeons performing >or=100 endocrine operations annually.
外科医生的经验与复杂手术预后的改善相关。内分泌手术越来越多地在门诊进行，而门诊手术的预后尚未得到系统研究。我们研究了外科医生手术量对甲状腺、甲状旁腺和肾上腺手术在住院和门诊环境下的临床及经济预后的影响。
研究了纽约州和佛罗里达州2002年的出院数据。外科医生按年度内分泌手术量分组：A组，1至3例手术；B组，4至8例；C组，9至19例；D组，20至50例；E组，51至99例；F组，≥100例。应用多元回归分析来分析并发症、住院时间（LOS）和总费用（TC），同时控制合并症、经济因素和以医院为中心的变量。
我们确定了13997例出院病例，其中28%的手术在门诊进行（同日入院/出院）。对于所有病例，A组并发症比例过高（观察值/期望值[O/E]1.65，P<.001），F组并发症比例过低（0.52；P<.001）。外科医生手术量高与住院时间缩短和总费用降低相关。医院手术量对预后的影响可忽略不计。
在内分泌手术中，外科医生手术量与并发症发生率、住院时间和总费用呈负相关。每年进行≥100例内分泌手术的外科医生并发症发生率最低。
