Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
Am J Obstet Gynecol. 2011 Sep;205(3):225.e1-7. doi: 10.1016/j.ajog.2011.04.014. Epub 2011 Apr 16.
We examined the influence of physician and hospital volume on the morbidity and mortality of radical hysterectomy for cervical cancer.
Women who underwent radical hysterectomy for cervical cancer between 2003 and 2007 were examined. The effect of surgeon and hospital volume on morbidity and mortality was examined using multivariable generalized estimating equations.
A total of 1536 women who underwent radical hysterectomy were identified. Patients treated by high-volume surgeons had fewer medical complications (odds ratio, 0.55; 95% confidence interval, 0.34-0.88) and shorter lengths of stay (odds ratio, 0.49; 95% confidence interval, 0.25-0.98). After adjustment for case mix and surgeon volume, hospital volume had no independent effect on any of the variables of interest.
High-volume surgeons have fewer postoperative medical complications, shorter lengths of stay, and lower transfusion requirements. Hospital volume appears to have only a minor influence on outcomes after radical hysterectomy.
研究医生和医院数量对宫颈癌根治性子宫切除术发病率和死亡率的影响。
对 2003 年至 2007 年间接受宫颈癌根治性子宫切除术的女性进行了检查。使用多变量广义估计方程研究了外科医生和医院数量对发病率和死亡率的影响。
共确定了 1536 例接受根治性子宫切除术的患者。由高容量外科医生治疗的患者医疗并发症较少（优势比，0.55；95%置信区间，0.34-0.88），住院时间较短（优势比，0.49；95%置信区间，0.25-0.98）。在调整病例组合和外科医生数量后，医院数量对所有感兴趣的变量均无独立影响。
高容量外科医生术后医疗并发症较少，住院时间较短，输血需求较低。医院数量对根治性子宫切除术的结果影响似乎很小。
