Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
Dis Colon Rectum. 2011 Jul;54(7):780-6. doi: 10.1007/DCR.0b013e31821484d2.
This study aimed to determine whether specialized surgeon practice improves clinical outcomes for major inpatient adult colorectal resections.
The Nationwide Inpatient Sample was queried for elective colorectal resections performed from 2001 through 2007. Specialization was determined by first identifying surgeons' procedures as either colorectal or noncolorectal. Surgeons were then stratified as either a specialized surgeon, if colorectal cases comprised more than 75% of their caseload, or a nonspecialized surgeon if colorectal cases comprised less than 75%.
The data points collected for these cases were: cost, length of stay, mortality, demographics, comorbidities, acuity of admission, hospital region, hospital location and teaching status, and primary payer information. Cost and length of stay were analyzed using a linear regression model with a log transformation for length of stay. A logistic regression analysis was performed for mortality. These models were adjusted for all other covariates including surgeon volume.
A total of 13,925 surgeons performing 115,540 procedures were analyzed. Specialized surgeons comprised 4.6% of surgeons and performed 17.0% of resections. In multivariate analysis, specialized surgeons had a lower risk of mortality (OR 0.72; CI 0.57-0.90, P = .0044), decreased length of stay (absolute difference in days 0.23; CI 0.11-0.49, P = .0022), and similar hospital cost (absolute cost difference $420 less; CI $238 more to $1079 less, P = .211) compared with nonspecialized surgeons. Although cost was not significant at a 75% specialization cutoff, a relationship exists between lower hospitalization cost and increased surgeon specialization even when controlled for surgeon volume.
Surgical specialization leads to reductions in mortality, hospital days, and cost for inpatient colorectal care.
本研究旨在确定专业外科医生的实践是否能改善主要住院成人结直肠切除术的临床结果。
通过查询 2001 年至 2007 年进行的择期结直肠切除术的全国住院患者样本，确定专业化。首先确定外科医生的手术是结直肠手术还是非结直肠手术。然后，如果结直肠病例占其工作量的 75%以上，则将外科医生划分为专业外科医生，如果结直肠病例少于 75%，则划分为非专业外科医生。
收集这些病例的数据点包括：成本、住院时间、死亡率、人口统计学、合并症、入院严重程度、医院区域、医院位置和教学状态以及主要支付者信息。使用对数转换对住院时间进行线性回归模型分析成本和住院时间。使用逻辑回归分析死亡率。这些模型调整了所有其他协变量，包括外科医生的数量。
共分析了 13925 名外科医生进行的 115540 例手术。专业外科医生占外科医生的 4.6%，完成了 17.0%的切除术。在多变量分析中，专业外科医生的死亡率较低（OR 0.72；95%CI 0.57-0.90，P =.0044），住院时间较短（绝对差值为 0.23 天；95%CI 0.11-0.49，P =.0022），与非专业外科医生相比，医院费用相似（绝对费用差异为 420 美元；95%CI 238 美元至 1079 美元，P =.211）。尽管在 75%专业化截止值处成本不显著，但即使控制外科医生数量，较低的住院成本与外科医生专业化程度的提高之间也存在关系。
外科手术专业化可降低住院结直肠护理的死亡率、住院天数和成本。
