Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Spine (Phila Pa 1976). 2011 Nov 15;36(24):2069-75. doi: 10.1097/BRS.0b013e318202ac56.
Retrospective review.
To determine the correlation of surgeon/hospital volume with complication/mortality rates and with in-hospital health care utilization in lumbar spine surgery.
Studies have shown improved outcomes in patients treated by high-volume surgeons and hospitals. To our knowledge, no studies evaluate this relationship for lumbar spine surgery.
To evaluate the 1992-2005 data in the National Inpatient Sample, we used the International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9-CM) codes for lumbar spine surgery to identify relevant hospitalizations. We assessed 232,668 hospitalization records listed as posterolateral lumbar decompression with fusion and/or exploration/decompression of the spinal canal. Annual surgeon and hospital volumes were stratified into quartiles via identifier codes. Patient demographics and comorbidity status were recorded for each group. Mortality and morbidity were primary endpoints. We used the Shapiro-Wilk test for normality for the distribution of variables; one-way analysis of variance to assess continuous measures; χ statistics for categorical measures; and logistic regression for the effect of procedure on the probability of morbidity and mortality, adjusting for confounding variables, including patient demographics. Logistic regression data were tabulated as odd ratios (ORs) and 95% confidence intervals (CIs) (statistical significance, P < 0.05).
When controlled for other variables, mortality was significantly lower in the highest volume hospitals (OR, 0.78; 95% CI 0.66 to 0.89) and among the highest volume surgeons (OR, 0.66; 95% CI 0.59 to 0.89) than in their lowest volume counterparts. The complication rate was slightly lower in the highest volume hospitals (OR, 0.94; 95% CI 0.81 to 0.99) and significantly lower among the highest volume surgeons (OR, 0.73; 95% CI 0.68 to 0.91) than in their lowest volume counterparts.
The mortality and complication rates associated with lumbar spine surgery are lower when patients are treated by high-volume surgeons and hospitals.
回顾性研究。
确定外科医生/医院的数量与并发症/死亡率之间的相关性，并确定腰椎手术的住院医疗利用率。
研究表明，接受高容量外科医生和医院治疗的患者的结果得到了改善。据我们所知，尚无研究评估腰椎手术的这种关系。
为了评估 1992 年至 2005 年全国住院患者样本中的数据，我们使用国际疾病分类，第 9 修订版，临床修正版（ICD-9-CM）代码来识别相关的住院记录。我们评估了 232668 例记录为后路腰椎减压融合术和/或椎管探查/减压的住院记录。通过标识符代码将年度外科医生和医院的数量分层为四分位数。为每个组记录患者的人口统计学和合并症状况。死亡率和发病率是主要终点。我们使用 Shapiro-Wilk 检验来检验变量的正态分布；使用单因素方差分析评估连续变量；使用卡方检验评估分类变量；使用逻辑回归评估手术对发病率和死亡率的影响，同时调整混杂变量，包括患者的人口统计学。逻辑回归数据以比值比（OR）和 95%置信区间（CI）（统计学意义，P < 0.05）表示。
在控制其他变量的情况下，高容量医院（OR，0.78；95%CI，0.66 至 0.89）和高容量外科医生（OR，0.66；95%CI，0.59 至 0.89）的死亡率明显低于低容量医院。高容量医院的并发症发生率略低（OR，0.94；95%CI，0.81 至 0.99），高容量外科医生的并发症发生率明显低于低容量外科医生（OR，0.73；95%CI，0.68 至 0.91）。
当患者由高容量外科医生和医院治疗时，腰椎手术相关的死亡率和并发症发生率较低。
