Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Japan.
Urology. 2010 Sep;76(3):548-52. doi: 10.1016/j.urology.2010.03.021. Epub 2010 May 7.
Previous studies on the relationship between nephrectomy volume and outcomes focused mainly on operative mortality. Little is known about the association between operative volume and postoperative complications. This study analyzed the influence of hospital volume on postoperative complications and in-hospital mortality after nephrectomy or nephroureterectomy.
Using the Diagnosis Procedure Combination database in Japan, 7988 patients undergoing nephrectomy or nephroureterectomy between July and December in 2006 and 2007 were identified. The cases were divided into low (≤26/y), medium (27-64), or high (≥65) hospital volume groups. Logistic regression analyses were performed to model the concurrent effects of hospital volume and other factors on postoperative complications and in-hospital mortality.
In-hospital mortality was 0.84%. The overall postoperative complication rate was 7.4%. Factors associated with mortality or morbidity were age, hypertension, chronic lung diseases, cardiac diseases, chronic renal failure, and duration of anesthesia. Video-assisted surgery showed a significantly lower rate of mortality (odds ratio [OR], 0.28; P <.01) and postoperative complications (OR, 0.47; P <.01) than open surgery. The difference of mortality between high and low-volume groups was not significant (0.5% vs 1.0%) (OR, 0.48; P = .089). Although higher hospital volume was associated with fewer postoperative complications (OR, 0.72; P = .014), the difference was slight (7.1% vs 7.8%).
Less comorbidity and invasive surgery and shorter anesthesia were associated with lower mortality and morbidity after renal surgery. Despite volume disparities, the magnitude of difference was only 0.7% in complications and 0.5% in mortality.
之前关于肾切除术量与结果关系的研究主要集中在手术死亡率上。关于手术量与术后并发症之间的关联知之甚少。本研究分析了医院量对肾切除术或肾输尿管切除术术后并发症和住院内死亡率的影响。
使用日本的诊断程序组合数据库，确定了 2006 年 7 月至 12 月期间接受肾切除术或肾输尿管切除术的 7988 例患者。将病例分为低（≤26/y）、中（27-64）或高（≥65）医院量组。使用逻辑回归分析模型来模拟医院量和其他因素对术后并发症和住院内死亡率的并发影响。
住院内死亡率为 0.84%。总体术后并发症发生率为 7.4%。与死亡率或发病率相关的因素是年龄、高血压、慢性肺部疾病、心脏病、慢性肾衰竭和麻醉持续时间。与开放手术相比，电视辅助手术显示出明显较低的死亡率（比值比 [OR]，0.28；P<.01）和术后并发症发生率（OR，0.47；P<.01）。高容量组和低容量组之间的死亡率差异无统计学意义（0.5%对 1.0%）（OR，0.48；P=0.089）。尽管较高的医院量与较少的术后并发症相关（OR，0.72；P=0.014），但差异很小（7.1%对 7.8%）。
较少的合并症和侵入性手术以及较短的麻醉与肾手术后较低的死亡率和发病率相关。尽管存在量的差异，但并发症的差异仅为 0.7%，死亡率的差异仅为 0.5%。
