Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Urology. 2013 Sep;82(3):572-7. doi: 10.1016/j.urology.2013.04.054.
To determine whether surgeon or hospital volume effects in-hospital mortality or complications of radical nephrectomy with concomitant removal of inferior vena cava (IVC) thrombus, we examine a national population-based cohort. Radical nephrectomy with removal of IVC thrombus is a complex urologic operation, which, similar to other major surgical procedures, may have an association between provider volume and outcomes.
Canadian Institute for Health Information administrative codes were used to identify nephrectomies associated with IVC manipulation in Canada from 1998 to 2007. Canadian Institute for Health Information databases yielded information on in-hospital mortality and complications for the hospital admission at surgery. Multivariate regression analysis was performed to assess the effect of surgeon and hospital volume on in-hospital mortality and complications, adjusting for age, sex, comorbidity, year of surgery, and region.
During the study period, 816 radical nephrectomies with associated IVC thrombectomy were performed on 521 men and 295 women. The in-hospital mortality rate was 7%. Notably, 75% of deaths occurred in the first 2 cases of surgeon experience. Median length of stay was 10 days. Complications were noted in 633 patients (78%). Fifty-eight patients with concomitant cardiac bypass had increased in-hospital mortality and complications. Age, comorbidity, and cardiac bypass were the strongest predictors of in-hospital mortality. Increasing surgeon volume, but not hospital volume, was associated with lower in-hospital mortality on multivariate regression analysis; however, this was not statistically significant.
Radical nephrectomy with associated IVC thrombectomy has significant complications and mortality. Surgeon but not hospital volume may affect outcomes.
通过考察全国范围内的人群队列，确定外科医生或医院的手术量对根治性肾切除术联合下腔静脉（IVC）血栓切除术的院内死亡率或并发症的影响。根治性肾切除术联合 IVC 血栓切除术是一种复杂的泌尿科手术，类似于其他主要外科手术，可能与手术提供者的手术量和结果之间存在关联。
使用加拿大健康信息研究所的管理代码，从 1998 年至 2007 年在加拿大识别与 IVC 操作相关的肾切除术。加拿大健康信息研究所的数据库提供了手术时住院期间死亡率和并发症的信息。进行多变量回归分析，以评估外科医生和医院手术量对住院期间死亡率和并发症的影响，调整因素包括年龄、性别、合并症、手术年份和地区。
在研究期间，521 名男性和 295 名女性共进行了 816 例根治性肾切除术和相关的 IVC 血栓切除术。院内死亡率为 7%。值得注意的是，75%的死亡发生在外科医生经验的前 2 例中。中位住院时间为 10 天。633 例患者（78%）出现并发症。58 例合并心脏旁路手术的患者的院内死亡率和并发症增加。年龄、合并症和心脏旁路是院内死亡率的最强预测因素。多变量回归分析显示，外科医生手术量的增加与较低的院内死亡率相关，但无统计学意义；而医院手术量与院内死亡率无关。
根治性肾切除术联合 IVC 血栓切除术具有显著的并发症和死亡率。外科医生的手术量而非医院的手术量可能会影响结果。
