Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Laryngoscope. 2011 Jan;121(1):85-90. doi: 10.1002/lary.21348.
To evaluate the impact of surgeon and hospital case volume and other related variables on short-term outcomes after surgery for laryngeal cancer.
The Maryland Health Service Cost Review Commission database was queried for laryngeal cancer surgical case volumes from 1990 to 2009. Multivariate logistic regression analyses and multiple linear regression models were used to evaluate for significant associations between surgeon and hospital case volume, as well as other independent variables and the risk of in-hospital death, postoperative wound complications, length of hospital stay, and hospital-related cost of care.
Overall, 1,981 laryngeal cancer surgeries were performed with complete financial data available for 1,885 laryngeal cancer surgeries, performed by 284 surgeons at 37 hospitals. The only independently significant factor associated with the risk of in-hospital death was an APR-DRG mortality risk score of 4 (odds ratio [OR] = 10.7, P < .001). Postoperative wound fistula or dehiscence was associated with an increased mortality risk score (OR = 3.1, P < .001), total laryngectomy (OR = 12.4, P = .013), and flap reconstruction (OR = 3.8, P = .001). Increased mortality risk score, partial or total laryngectomy, flap reconstruction, and Black race were associated with an increased length of stay and hospital-related costs. After controlling for all other variables, a statistically significant negative correlation was observed between surgery at a high-volume hospital and both length of hospital stay (geometric mean = -1.5 days, P = .003). and hospital-related costs (geometric mean = -$6,061, P = .003).
After controlling for other factors, high-volume hospital care is associated with a shorter length of hospitalization and lower hospital-related cost of care for laryngeal cancer surgery.
评估外科医生和医院手术量以及其他相关变量对喉癌手术后短期结果的影响。
从 1990 年至 2009 年，查询马里兰州医疗服务成本审查委员会数据库中的喉癌手术病例量。采用多变量逻辑回归分析和多元线性回归模型，评估外科医生和医院手术量与住院死亡风险、术后伤口并发症、住院时间和医院相关医疗费用之间的显著关联，以及其他独立变量。
共有 1981 例喉癌手术，其中 1885 例手术有完整的财务数据，由 284 名外科医生在 37 家医院完成。唯一与住院死亡风险相关的独立显著因素是 APR-DRG 死亡率风险评分 4 分（比值比 [OR] = 10.7，P <.001）。术后伤口瘘或裂开与死亡率风险评分升高相关（OR = 3.1，P <.001）、全喉切除术（OR = 12.4，P =.013）和皮瓣重建（OR = 3.8，P =.001）。死亡率风险评分升高、部分或全喉切除术、皮瓣重建和黑人种族与住院时间延长和医院相关费用增加相关。在控制所有其他变量后，高手术量医院与住院时间（几何平均值=-1.5 天，P =.003）和医院相关费用（几何平均值=-$6061，P =.003）呈显著负相关。
在控制其他因素后，高手术量医院的护理与喉癌手术的住院时间缩短和医院相关医疗费用降低相关。
