University of Montreal Health Center, Montreal, Quebec, Canada.
J Urol. 2012 Feb;187(2):405-10. doi: 10.1016/j.juro.2011.10.025. Epub 2011 Dec 15.
We examined the impact of hospital volume on short-term outcomes after nephrectomy for nonmetastatic renal cell carcinoma.
Using the Nationwide Inpatient Sample we identified 48,172 patients with nonmetastatic renal cell carcinoma treated with nephrectomy (1998 to 2007). Postoperative complications, blood transfusions, prolonged length of stay and in-hospital mortality were examined. Stratification was performed according to teaching status, nephrectomy type (partial vs radical nephrectomy) and surgical approach (open vs laparoscopic). Multivariable logistic regression models were fitted.
Patients treated at high volume centers were younger and healthier at nephrectomy. High hospital volume predicted lower blood transfusion rates (8.5% vs 9.7% vs 11.8%), postoperative complications (14.4% vs 16.6% vs 17.2%) and shorter length of stay (43.1% vs 49.8% vs 54.0%, all p <0.001). In multivariable analyses stratified according to teaching status, nephrectomy type and surgical approach, high hospital volume was an independent predictor of lower rates of postoperative complications (OR 0.73-0.88), blood transfusions (OR 0.71-0.78) and prolonged length of stay (OR 0.76-0.89, all p <0.001). Exceptions were postoperative complications at nonteaching centers (OR 0.94, p >0.05) and blood transfusions in nephrectomies performed laparoscopically (OR 0.68, p >0.05).
On average, high hospital volume results in more favorable outcomes during hospitalization after nephrectomy.
我们研究了医院手术量对局限性肾细胞癌患者肾切除术短期预后的影响。
我们利用全国住院患者样本，共纳入 48172 例局限性肾细胞癌患者（1998 年至 2007 年），这些患者接受了肾切除术治疗。术后并发症、输血、住院时间延长和院内死亡率是我们观察的指标。按照教学医院与否、肾切除术类型（部分肾切除术与根治性肾切除术）和手术途径（开放性手术与腹腔镜手术）进行分层。多变量逻辑回归模型用于分析。
在高手术量中心治疗的患者在接受肾切除术时年龄更小且更健康。高手术量医院预测更低的输血率（8.5%比 9.7%比 11.8%）、更低的术后并发症发生率（14.4%比 16.6%比 17.2%）和更短的住院时间（43.1%比 49.8%比 54.0%，所有 P 值均＜0.001）。按照教学医院与否、肾切除术类型和手术途径进行多变量分析，高手术量是术后并发症（OR 0.73-0.88）、输血（OR 0.71-0.78）和住院时间延长（OR 0.76-0.89）发生率较低的独立预测因子（所有 P 值均＜0.001）。但是，非教学医院的术后并发症发生率（OR 0.94，P＞0.05）和腹腔镜肾切除术的输血率（OR 0.68，P＞0.05）除外。
平均而言，高手术量会导致肾切除术后住院期间的预后更好。
