外科医生手术量对阴道子宫切除术结局和资源利用的影响。

The effect of surgeon volume on outcomes and resource use for vaginal hysterectomy.

机构信息

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; and the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.

出版信息

Obstet Gynecol. 2010 Dec;116(6):1341-1347. doi: 10.1097/AOG.0b013e3181fca8c5.

DOI:10.1097/AOG.0b013e3181fca8c5

PMID:21099600

Abstract

OBJECTIVE

To estimate the effect of surgical volume on outcomes and resource use in women undergoing vaginal hysterectomy.

METHODS

Women who underwent total vaginal hysterectomy and were registered in the Perspective database were examined. Perspective is a nationwide database developed to measure quality and resource use. Procedure-associated intraoperative, perioperative, and postoperative medical complications as well as hospital readmission, length of stay, intensive care unit (ICU) use, operating time, and cost were analyzed. Based on the overall gynecologic surgical volume and vaginal surgical volume of their surgeons, patients were stratified into tertiles. Complications were compared using adjusted generalized estimating equations and reported as odds ratios (ORs).

RESULTS

A total of 77,109 patients operated on by 6,195 gynecologic surgeons were identified. After adjustment for the effects of other demographic variables and concomitant procedures, patients operated on by high-volume vaginal surgeons were 31% (OR 0.69; 95% confidence interval [CI] 0.59-0.80) less likely to experience an operative injury, whereas perioperative complications were reduced by 19% (OR 0.81; 95% CI 0.72-0.92), medical complications decreased by 24% (OR 0.76; 95% CI 0.67-0.86), ICU admission reduced by 46% (OR 0.56; 95% CI 0.43-0.73), and the transfusion rate decreased by 28% (OR 0.72; 95% CI 0.61-0.85) in patients treated by high-volume vaginal surgeons, whereas rates of readmission were higher (OR 1.24; 95% CI 1.04-1.47) in patients treated by high-volume surgeons. Operative times were lower in patients operated on by high-volume surgeons (P<.001). Although total gynecologic surgical volume had no effect on cost, patients treated by high-volume vaginal surgeons had lower costs (P<.001).

CONCLUSION

Perioperative morbidity and resource use are lower in women undergoing vaginal hysterectomy when the procedure is performed by high-volume vaginal surgeons.

摘要

目的

评估手术量对行阴道子宫切除术女性结局和资源利用的影响。

方法

对接受全阴道子宫切除术并在 Perspective 数据库中登记的女性进行了检查。Perspective 是一个旨在衡量质量和资源利用的全国性数据库。分析了与手术相关的术中、围手术期和术后医疗并发症以及医院再入院、住院时间、重症监护病房（ICU）使用、手术时间和成本。根据其外科医生的整体妇科手术量和阴道手术量，患者分为三分位。使用调整后的广义估计方程比较并发症，并报告为优势比（OR）。

结果

共确定了 77109 名由 6195 名妇科外科医生进行手术的患者。调整其他人口统计学变量和伴随手术的影响后，由高容量阴道外科医生手术的患者发生手术损伤的可能性降低 31%（OR 0.69；95%置信区间[CI]0.59-0.80），围手术期并发症减少 19%（OR 0.81；95%CI0.72-0.92），医疗并发症减少 24%（OR 0.76；95%CI0.67-0.86），ICU 入院减少 46%（OR 0.56；95%CI0.43-0.73），输血率降低 28%（OR 0.72；95%CI0.61-0.85），由高容量阴道外科医生治疗的患者，而高容量外科医生治疗的患者再入院率更高（OR 1.24；95%CI1.04-1.47）。由高容量外科医生进行手术的患者手术时间更短（P<.001）。尽管总妇科手术量对成本没有影响，但由高容量阴道外科医生治疗的患者成本更低（P<.001）。