Park Henry S, Roman Sanziana A, Sosa Julie Ann
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Arch Surg. 2009 Nov;144(11):1060-7. doi: 10.1001/archsurg.2009.191.
To assess the effect of surgeon volume and specialty on clinical and economic outcomes after adrenalectomy.
Population-based retrospective cohort analysis.
Healthcare Cost and Utilization Project Nationwide Inpatient Sample.
Adults (>or=18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, surgeon specialty (general vs urologist), surgeon adrenalectomy volume, and hospital factors were assessed.
The chi(2) test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs.
A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white. A higher proportion of general surgeons were high-volume surgeons compared with urologists (34.1% vs 18.2%, P < .001). Low-volume surgeons had more complications (18.2% vs 11.3%, P < .001) and their patients had longer LOS (5.5 vs 3.9 days, P < .001) than did high-volume surgeons; urologists had more complications (18.4% vs 15.2%, P = .03) and higher costs ($13,168 vs $11,732, P = .02) than did general surgeons. After adjustment for patient and provider characteristics in multivariate analyses, surgeon volume, but not specialty, was an independent predictor of complications (odds ratio = 1.5, P < .002) and LOS (1.0-day difference, P < .001). Hospital volume was associated only with LOS (0.8-day difference, P < .007). Surgeon volume, specialty, and hospital volume were not predictors of costs.
To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice.
评估外科医生手术量及专业对肾上腺切除术后临床和经济结局的影响。
基于人群的回顾性队列分析。
医疗成本与利用项目全国住院患者样本。
1999 - 2005年在美国接受肾上腺切除术的成年人（≥18岁）。评估了患者的人口统计学和临床特征、外科医生专业（普通外科医生与泌尿外科医生）、外科医生肾上腺切除手术量以及医院因素。
采用卡方检验、方差分析以及多元线性和逻辑回归来评估住院并发症、平均住院时间（LOS）和住院总费用。
共纳入3144例肾上腺切除术。患者平均年龄为53.7岁；58.8%为女性，77.4%为白人。与泌尿外科医生相比，普通外科医生中高手术量医生的比例更高（34.1%对18.2%，P <.001）。低手术量外科医生的并发症更多（18.2%对11.3%，P <.001），其患者的住院时间更长（5.5天对3.9天，P <.001）；泌尿外科医生的并发症比普通外科医生更多（18.4%对15.2%，P =.03），费用更高（13,168美元对11,732美元，P =.02）。在多变量分析中对患者和医疗服务提供者特征进行调整后，外科医生手术量而非专业是并发症（比值比 = 1.5，P <.002）和住院时间（相差1.0天，P <.001）的独立预测因素。医院手术量仅与住院时间相关（相差0.8天，P <.007）。外科医生手术量、专业和医院手术量均不是费用的预测因素。
为优化结局，肾上腺疾病患者应根据外科医生的肾上腺手术量和腹腔镜手术专业技能转诊，而不考虑其专业领域。
