Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Ann Surg Oncol. 2012 Mar;19(3):948-58. doi: 10.1245/s10434-011-2090-8. Epub 2011 Oct 12.
The volume of surgical procedures performed by hospitals and surgeons has a strong influence on outcomes for a number of surgeries. We examined the influence of surgeon and hospital case volume on morbidity, mortality, and resource utilization for women with endometrial cancer undergoing laparoscopic hysterectomy.
Perspective, a nationwide inpatient database developed to measure utilization and quality, was used to examine women with endometrial cancer who underwent laparoscopic hysterectomy with or without lymphadenectomy from 2000 to 2010. Perioperative morbidity, mortality, and cost were compared using Chi-square tests and multivariable generalized estimating equations.
A total of 4,137 patients were identified. The overall complication rate was 9.8% for low-volume vs. 10.4% for high-volume surgeons [multivariable odds ratio (OR) = 0.71; 95% confidence interval (CI), 0.41-1.22]. The rates of intraoperative complications, surgical-site complications, medical complications, transfusion, and reoperation were similar for patients treated by low- and high-volume surgeons (p > 0.05 for all). The adjusted estimate for hospital cost for patients treated by high- compared with low-volume surgeons was 219 USD (95% CI, -790 to 1,228 USD). The odds ratio for any complication in high- compared with low-volume hospitals was 1.24 (95% CI, 0.78-1.96). The average cost for patients treated in high- compared with low-volume facilities was -815 USD (95% CI, -1,641 to 11 USD). Neither physician nor hospital volume had a statistically significant effect on perioperative mortality.
Laparoscopic hysterectomy for endometrial cancer is well tolerated and associated with an acceptable morbidity profile. Surgeon and hospital volume appear to have little effect on perioperative morbidity, mortality, and resource utilization.
医院和外科医生所进行的手术量对许多手术的结果有很大影响。我们研究了外科医生和医院手术量对接受腹腔镜子宫切除术的子宫内膜癌女性的发病率、死亡率和资源利用的影响。
使用 Perspective 进行分析，这是一个全国性的住院患者数据库，用于衡量利用情况和质量，研究了 2000 年至 2010 年期间接受腹腔镜子宫切除术（伴或不伴淋巴结切除术）的子宫内膜癌女性。使用卡方检验和多变量广义估计方程比较围手术期发病率、死亡率和成本。
共确定了 4137 例患者。低容量组的总体并发症发生率为 9.8%，高容量组为 10.4%[多变量优势比（OR）=0.71；95%置信区间（CI），0.41-1.22]。低容量组和高容量组患者的术中并发症、手术部位并发症、医疗并发症、输血和再次手术发生率相似（所有 p 值>0.05）。与低容量外科医生相比，高容量外科医生治疗的患者的医院成本调整估计值为 219 美元（95%CI，-790 至 1228 美元）。高容量与低容量医院相比任何并发症的 OR 为 1.24（95%CI，0.78-1.96）。与低容量设施相比，高容量设施治疗的患者的平均成本为-815 美元（95%CI，-1641 至 11 美元）。无论是医生还是医院的容量都没有对围手术期死亡率产生统计学上的显著影响。
腹腔镜子宫切除术治疗子宫内膜癌患者耐受性良好，发病率适中。外科医生和医院的容量似乎对围手术期发病率、死亡率和资源利用影响不大。
