Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.
Br J Surg. 2013 Aug;100(9):1189-96. doi: 10.1002/bjs.9199.
Service reorganization to concentrate complex vascular services in hospitals with high caseload volume aims to reduce mortality and complication rates. The present study assessed the relationship between caseload volume and outcome for iliac artery angioplasty and stenting in England using a routinely available national data set (Hospital Episode Statistics, HES).
Routine administrative data for iliac artery angioplasty and stent procedures performed in England between 2007 and 2011 were analysed. Associations between centre volume and outcomes (death, complications and duration of hospital stay) were tested and compared for two methods of stratification (quartiles and quintiles) and two statistical tests (odds ratios and the Cochran-Armitage test for trend). Multivariable analysis was also performed.
There were 23,308 episodes of care recorded in HES with Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, fourth revision, codes L54.1 or L54.4 corresponding to iliac artery intervention. There was a gradual increase year by year in number of procedures performed. Univariable and multivariable analysis showed no association between centre volume and either death or complications (multivariable odds ratio, OR 1.00, 95 per cent confidence interval 1.00 to 1.00) for elective and non-elective procedures. Age was associated with higher mortality and complication rates in elective procedures, and with mortality in non-elective procedures. The risk of death after elective iliac angioplasty or stenting was significantly higher in women (multivariable OR 4.98, 2.09 to 13.26).
There was no association between the outcomes of endovascular iliac artery intervention and centre volume, but outcomes were significantly worse with increasing age and female sex.
将复杂的血管服务集中在高病例量的医院以进行服务重组，旨在降低死亡率和并发症发生率。本研究使用常规可得的国家数据集（医院出院统计，HES）评估了英国髂动脉血管成形术和支架置入术的病例量与结局之间的关系。
分析了 2007 年至 2011 年期间在英国进行的髂动脉血管成形术和支架置入术的常规行政数据。使用两种分层方法（四分位法和五分位法）和两种统计检验（比值比和 Cochran-Armitage 趋势检验）检验并比较了中心容量与结局（死亡、并发症和住院时间）之间的关系。还进行了多变量分析。
HES 记录了 23308 例接受 Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures，第四版，L54.1 或 L54.4 手术操作代码治疗的髂动脉干预患者。每年实施的手术数量呈逐渐增加趋势。单变量和多变量分析均显示，选择性和非选择性手术中，中心容量与死亡或并发症之间无关联（多变量比值比，OR 1.00，95%置信区间 1.00 至 1.00）。在选择性手术中，年龄与更高的死亡率和并发症发生率相关，而非选择性手术中与死亡率相关。女性选择性髂动脉血管成形术或支架置入术后死亡风险显著升高（多变量 OR 4.98，2.09 至 13.26）。
血管内髂动脉介入治疗的结局与中心容量之间无关联，但随着年龄和女性性别增加，结局明显变差。
