安大略省初次全关节置换术的提供者数量和早期结果。
Provider volumes and early outcomes of primary total joint replacement in Ontario.
机构信息
The Institute for Clinical Evaluative Sciences, Toronto, Ont., Canada.
出版信息
Can J Surg. 2010 Jun;53(3):175-83.
BACKGROUND
A relation between provider volume and outcome of total joint replacement (TJR) has not been demonstrated in Canada. Given the recent increase in TJR, changing patient characteristics and small sizes of previous Ontario studies, we reassessed whether adverse outcomes of TJR are related to hospital and surgeon procedure volumes.
METHODS
We included all Ontarians aged 20 years and older who underwent a unilateral elective primary total hip replacement (THR) or total knee replacement (TKR) between April 2000 and March 2004. The main data sources were hospital discharge abstracts and physician billings. We defined provider volume as the average annual number of primary and revision procedures performed by hospitals and surgeons during the study period. We assessed the association between procedure volumes and acute length of hospital stay (ALOS) and between volume and rate of surgical complications during the index admission; death within 90 days of operation; readmission for amputation, fusion or excision within 1 year; and revision arthroplasty within 1 year. We adjusted for age, sex, comorbidity, arthritis type, teaching hospital status and discharge disposition. The analyses of hospital volume were adjusted for surgeon volume and vice versa.
RESULTS
We included 20,290 patients who received THR and 27,217 who received TKR. Patient age, sex and comorbidity were significant predictors of complications and mortality. There were no associations between provider volume and mortality. Findings for other outcomes were mixed. Surgeon procedure volume was related to rates of revision THR but not to rates of revision TKR. Shorter ALOS was associated with male sex, younger age, fewer comorbidities, discharge to a rehabilitation unit or facility and greater surgeon volume.
CONCLUSION
Patient characteristics were significant predictors of complications, ALOS and mortality after primary TJR. Evidence for a relation between provider volume and outcome was limited and inconsistent.
背景
在加拿大，提供者数量与全关节置换术（TJR）的结果之间没有关系。鉴于 TJR 的最近增加，患者特征的变化以及安大略省先前研究的规模较小，我们重新评估了 TJR 的不良结果是否与医院和外科医生手术量有关。
方法
我们纳入了所有在 2000 年 4 月至 2004 年 3 月期间接受单侧选择性初次全髋关节置换术（THR）或全膝关节置换术（TKR）的 20 岁及以上的安大略省居民。主要数据来源是医院出院摘要和医生账单。我们将提供者数量定义为医院和外科医生在研究期间进行的初次和翻修手术的平均年数量。我们评估了手术量与急性住院时间（ALOS）之间的关联，以及与指数入院期间手术并发症的发生率之间的关联；术后 90 天内死亡；术后 1 年内因截肢，融合或切除而再次入院；以及术后 1 年内进行关节翻修术。我们根据年龄，性别，合并症，关节炎类型，教学医院状况和出院处置进行了调整。对医院数量的分析进行了调整，以适应外科医生的数量，反之亦然。
结果
我们纳入了 20290 例接受 THR 的患者和 27217 例接受 TKR 的患者。患者的年龄，性别和合并症是并发症和死亡率的重要预测因素。提供者数量与死亡率之间没有关联。其他结果的发现则各不相同。外科医生手术量与 THR 翻修率有关，但与 TKR 翻修率无关。较短的 ALOS 与男性，年轻，较少的合并症，出院到康复病房或设施以及外科医生数量较多有关。
结论
患者特征是初次 TJR 后并发症，ALOS 和死亡率的重要预测因素。提供者数量与结果之间的关系证据有限且不一致。
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