School of Public Health, The University of Tokyo, Tokyo, Japan.
J Urol. 2011 Jun;185(6):2248-53. doi: 10.1016/j.juro.2011.01.080. Epub 2011 Apr 16.
We analyzed the impact of hospital volume and laser use on postoperative complications and in-hospital mortality in transurethral prostatic surgery.
We evaluated data from 18,578 patients in 686 hospitals who underwent transurethral prostatic surgery between July and December, 2006 to 2008, using the Diagnosis Procedure Combination database in Japan. Cases were divided into low (14 or less per year), medium (14 to 29 per year) or high (30 or more per year) hospital volume groups. Logistic regression analyses were conducted to determine the concurrent effects of hospital volume, laser use and other factors on postoperative complications, transfusion and in-hospital mortality. Laser devices included neodymium:yttrium aluminum garnet and holmium:yttrium aluminum garnet lasers.
The overall in-hospital mortality was 0.05% (10 of 18,578 patients) and was not significantly different among groups. The transfusion rates of the low, medium and high volume groups were 8.3%, 7.0% and 5.5%, respectively (low vs high volume adjusted odds ratio 1.55, p <0.01), and postoperative complication rates were 3.7%, 3.2% and 2.6% (low vs high volume OR 1.425, p = 0.016), respectively. An absence of laser use was also a significant risk factor on both measures (OR 1.46 and 2.02, both p <0.01). Teaching hospitals were associated with a higher transfusion rate (OR 1.75), and comorbidities of chronic lung disease, chronic renal failure and malignancy were related to complication rates (OR 1.89, 2.32 and 1.50, respectively).
The mortality rate of transurethral prostatic surgery is extremely low and is not affected by hospital volume. However, higher surgical volumes and laser use were significantly associated with lower rates of complications and transfusions.
我们分析了医院手术量和激光使用对经尿道前列腺手术术后并发症和住院死亡率的影响。
我们使用日本诊断程序组合数据库，评估了 2006 年 7 月至 2008 年 12 月期间在 686 家医院接受经尿道前列腺手术的 18578 名患者的数据。病例分为低（每年 14 例或以下）、中（每年 14-29 例）或高（每年 30 例或以上）手术量组。采用 logistic 回归分析确定医院手术量、激光使用和其他因素对术后并发症、输血和住院死亡率的并发影响。激光设备包括钕：钇铝石榴石和钬：钇铝石榴石激光。
总体住院死亡率为 0.05%（18578 例患者中有 10 例），各组间无显著差异。低、中、高手术量组的输血率分别为 8.3%、7.0%和 5.5%（低 vs 高手术量调整比值比 1.55，p<0.01），术后并发症发生率分别为 3.7%、3.2%和 2.6%（低 vs 高手术量 OR 1.425，p=0.016）。不使用激光也是这两个指标的显著危险因素（OR 1.46 和 2.02，均 p<0.01）。教学医院与较高的输血率相关（OR 1.75），慢性肺部疾病、慢性肾衰竭和恶性肿瘤等合并症与并发症发生率相关（OR 1.89、2.32 和 1.50）。
经尿道前列腺手术的死亡率极低，不受医院手术量的影响。然而，较高的手术量和激光使用与并发症和输血率的降低显著相关。
