David Guy, Gunnarsson Candace L, Moore Matt, Howington John, Miller Daniel L, Maddaus Michael A, McKenna Robert Joseph, Meyers Bryan F, Swanson Scott J
Associate Professor of Health Care Management, The Wharton School, University of Pennsylvania, 202 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA.
Minim Invasive Surg. 2012;2012:760292. doi: 10.1155/2012/760292. Epub 2012 Nov 4.
This study examined the effect of surgeons' volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.
本研究考察了外科医生手术量对肺手术（肺叶切除术和楔形切除术）结果的影响。此外，还分析了电视辅助胸腔镜手术（VATS）对成本、利用率和不良事件的影响。Premier医院数据库是本次分析的数据源。符合条件的患者为任何年龄、接受VATS肺叶切除术或楔形切除术以治疗癌症的患者。手术量由每位外科医生在每次手术前六个月内的总体经验水平表示。研究发现手术量与结果之间存在正相关关系，且有一些显著特征。成本和利用率结果方面的关系比不良事件方面更强；胸外科医生的情况与其他外科医生不同；VATS肺叶切除术的情况比VATS楔形切除术更强。虽然随着VATS经验的增加，成本和资源利用率有所降低，但这些结果与开放手术经验的增加无关。
