Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Worcester, Massachusetts.
J Surg Res. 2013 Nov;185(1):433-40. doi: 10.1016/j.jss.2013.04.072. Epub 2013 May 21.
Specialized procedures such as hepatectomy are performed by a variety of specialties in surgery. We aimed to determine whether variation exists among utilization of resources, cost, and patient outcomes by specialty, surgeon case volume, and center case volume for hepatectomy.
We queried centers (n = 50) in the University Health Consortium database from 2007-2010 for patients who underwent elective hepatectomy in which specialty was designated general surgeon (n = 2685; 30%) or specialist surgeon (n = 6277; 70%), surgeon volume was designated high volume (>38 cases annually) and center volume was designated high volume (>100 cases annually). We then stratified our cohort by primary diagnosis, defined as primary tumor (n = 2241; 25%), secondary tumor (n = 5466; 61%), and benign (n = 1255; 14%).
Specialist surgeons performed more cases for primary malignancy (primary 26% versus 15%) while general surgeons operated more for secondary malignancies (67% versus 61%) and benign disease (18% versus 13%). Specialists were associated with a shorter total length of stay (LOS) (5 d versus 6 d; P < 0.01) and lower in-hospital morbidity (7% versus 11%; P < 0.01). Patients treated by high volume surgeons or at high volume centers were less likely to die than those treated by low volume surgeons or at low volume centers, (OR 0.55; 95% CI 0.33-0.89) and (OR 0.44; 95% CI 0.13-0.56).
Surgical specialization, surgeon volume and center volume may be important metrics for quality and utilization in complex procedures like hepatectomy. Further studies are necessary to link direct factors related to hospital performance in the changing healthcare environment.
肝切除术等专业手术由多个外科专业进行。我们旨在确定专业、外科医生手术量和中心手术量是否会影响肝切除术的资源利用、成本和患者结局。
我们在 2007 年至 2010 年期间从大学健康联盟数据库中查询了 50 个中心（n = 50），这些中心的患者接受了择期肝切除术，指定外科医生为普通外科医生（n = 2685；30%）或专科外科医生（n = 6277；70%），外科医生手术量被指定为高手术量（>38 例/年），中心手术量被指定为高手术量（>100 例/年）。然后，我们根据主要诊断对队列进行分层，主要诊断定义为原发性肿瘤（n = 2241；25%）、继发性肿瘤（n = 5466；61%）和良性疾病（n = 1255；14%）。
专科外科医生对原发性恶性肿瘤的手术量更多（原发性 26%对 15%），而普通外科医生对继发性恶性肿瘤（67%对 61%）和良性疾病（18%对 13%）的手术量更多。专科医生的总住院时间（LOS）更短（5 天对 6 天；P < 0.01），住院并发症发生率更低（7%对 11%；P < 0.01）。与低手术量医生或低手术量中心相比，高手术量医生或高手术量中心治疗的患者死亡风险更低（OR 0.55；95%CI 0.33-0.89）和（OR 0.44；95%CI 0.13-0.56）。
在肝切除术等复杂手术中，外科专业、外科医生手术量和中心手术量可能是质量和利用的重要指标。在不断变化的医疗环境下，需要进一步研究与医院绩效相关的直接因素，以确定其联系。
