Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen, Berlin 12203, Germany.
BMJ Qual Saf. 2011 Dec;20(12):1069-74. doi: 10.1136/bmjqs.2011.051250. Epub 2011 Jul 18.
To examine the association between surgical department volume and the risk of surgical site infections (SSI) after orthopaedic procedures.
A minimum volume regulation of at least 50 knee replacements per year was implemented in 2006 in German surgical departments.
SSI rates were obtained from Krankenhaus-Infektions-Surveillance-System, the German national nosocomial infections surveillance system (January 2003-June 2008). The authors analysed the data by linear regression models. The adjusted ORs were estimated based on general estimating equation models to assess the independent effect of department volume (low, ie, ≤ 50, medium, ie, >50 and ≤ 100, and high, ie, >100 procedures annually).
A total of 206 surgical departments performed 14,339 arthroscopies, 63,045 knee replacements and 43,180 hip replacements during the 5.5-year study period. SSI rates were significantly higher in departments with a procedure volume of ≤ 50 arthroscopies and knee replacements. A higher threshold of 100 procedures per year did lead to a significant decrease in SSI rates for all three procedures in the univariate analysis. The multivariate analysis showed that the risk of SSI in low volume departments was sevenfold higher for arthroscopies and twofold higher for knee replacement than in medium volume departments. SSI risk after hip replacement was significantly lower in high volume centres.
The authors' findings offer some support for recommendations to concentrate arthroscopy and knee replacement in surgical departments with more than 50 procedures and hip replacement in departments with more than 100 procedures per year in order to reduce SSI.
探讨矫形手术后手术部位感染（SSI）与外科科室数量的关系。
2006 年，德国外科科室实施了至少每年 50 例膝关节置换术的最低数量规定。
从德国全国医院感染监测系统（Krankenhaus-Infektions-Surveillance-System）获取 SSI 发生率数据（2003 年 1 月至 2008 年 6 月）。作者通过线性回归模型分析数据。采用广义估计方程模型估计调整后的比值比（OR），以评估科室数量（低，即≤50 例；中，即>50 至≤100 例；高，即>100 例）的独立影响。
在 5.5 年的研究期间，共有 206 个外科科室进行了 14339 例关节镜检查、63045 例膝关节置换术和 43180 例髋关节置换术。手术量≤50 例关节镜检查和膝关节置换术的科室 SSI 发生率明显较高。每年 100 例手术的更高门槛确实导致所有三种手术的 SSI 率在单变量分析中显著降低。多变量分析显示，与中量科室相比，低量科室关节镜检查和膝关节置换术的 SSI 风险分别高出 7 倍和 2 倍。高量科室髋关节置换术后 SSI 的风险明显降低。
作者的研究结果为以下建议提供了一些支持：为了降低 SSI，应将关节镜检查和膝关节置换术集中在手术科室，每年手术量超过 50 例，髋关节置换术集中在每年手术量超过 100 例的科室。
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