年度手术量对微创前列腺切除术患者住院时间的影响：基于人群的研究。

Impact of annual surgical volume on length of stay in patients undergoing minimally invasive prostatectomy: a population-based study.

机构信息

Martiniclinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Eur J Surg Oncol. 2011 May;37(5):429-34. doi: 10.1016/j.ejso.2011.02.012.

DOI:10.1016/j.ejso.2011.02.012

PMID:21492776

Abstract

BACKGROUND

On average, patients remain hospitalized no more than 2 days after MIRP. The aim of our study was to examine the temporal trends in length of stay ≥ 3 days and to test the relationship between annual surgical volume (ASV) and annual hospital volume (AHV) and length of stay ≥ 3 days in patients undergoing MIRP.

MATERIAL AND METHODS

Within the Florida Hospital Inpatient Datafile, 2439 men who were treated with MIRP for prostate cancer between 2005 and 2008 were identified. Temporal trends were assessed and uni and multi-variable logistic regression models tested the relationship between ASV, AHV and length of stay ≥ 3 days.

RESULTS

The average length of stay decreased from 2.4 in 2005 to 1.7 days in 2008. Length of stay ≥ 3 days was recorded in 13.6% of patients and the proportion of patients staying more than ≥ 3 days decreased over time (25.5-12.2%; Chi Square trend p < 0.001). After stratification into low (<1-15 MIRPs) vs. intermediate (16-63 MIRPs) vs. high ASV tertiles (≥ 64 MIRPs) the proportion of patients with length of stay ≥ 3 days were 29.1; 13.2 and 11.1%. In multivariable logistic regression models predicting length of stay ≥ 3 days, ASV, year of surgery and comorbidities achieved independent predictor status and MIRP patients operated by highest ASV tertile surgeons were 71% (p < 0.001) less likely to be hospitalized for more than 3 days.

CONCLUSION

The length of stay after MIRP decreased between 2005 and 2008. Surgical expertise represented one of the main determinants of shorter length of stay.

摘要

背景

MIRP 术后患者平均住院时间不超过 2 天。本研究旨在分析住院时间≥3 天的时间趋势，并检验每年手术量（ASV）和每年医院容量（AHV）与 MIRP 术后住院时间≥3 天的关系。

材料和方法

在佛罗里达医院住院患者数据文件中，确定了 2005 年至 2008 年间 2439 例接受 MIRP 治疗前列腺癌的男性患者。评估了时间趋势，并采用单变量和多变量逻辑回归模型检验了 ASV、AHV 与住院时间≥3 天的关系。

结果

平均住院时间从 2005 年的 2.4 天降至 2008 年的 1.7 天。有 13.6%的患者住院时间≥3 天，且住院时间≥3 天的患者比例随时间呈下降趋势（25.5-12.2%；卡方趋势 p<0.001）。分层为低（<1-15 例 MIRP）、中（16-63 例 MIRP）和高 ASV 三分位数（≥64 例 MIRP）后，住院时间≥3 天的患者比例分别为 29.1%、13.2%和 11.1%。在多变量逻辑回归模型中，预测住院时间≥3 天的因素有 ASV、手术年份和合并症，ASV 成为独立预测因素，接受最高 ASV 三分位数外科医生手术的 MIRP 患者住院时间超过 3 天的可能性降低 71%（p<0.001）。