Department of Surgery, Imperial College, St Mary's Hospital, London, UK.
Br J Surg. 2013 Oct;100(11):1531-8. doi: 10.1002/bjs.9264.
The study aimed to explore the impact of surgeon and institution volume on outcome following colorectal surgery in England using multilevel hierarchical analysis.
An observational study design was used. All patients undergoing primary elective colorectal resection between 2000 and 2008 were included from the Hospital Episode Statistics database. Consultant surgeons and hospitals were divided into tertiles (low, medium and high volume) according to their mean annual colorectal cancer resection caseload. Outcome measures examined were postoperative 30-day mortality, 28-day readmission and reoperation, and length of stay. Hierarchical multiple regression analysis adjusted for age, sex, co-morbidity, social deprivation, year of surgery, operation type and surgical approach.
A total of 109 261 elective cancer colorectal resections were included. High-volume consultant surgeons and hospitals were defined as performing more than 20·7 and 103·5 elective colorectal cancer procedures per year respectively. Consultant and hospital operative volumes increased throughout the study period. In hierarchical regression models, greater surgeon and institutional volume independently predicted only shorter length of hospital stay. No statistical association was observed between higher provider volume and postoperative mortality, 28-day reoperation or readmission rates.
Increasing elective colorectal cancer caseload alone may have marginal postoperative benefit.
本研究旨在使用多层次层次分析探讨英国结直肠手术后外科医生和机构数量对结果的影响。
采用观察性研究设计。根据其平均年度结直肠癌切除术病例数,将 2000 年至 2008 年间接受原发性选择性结直肠切除术的所有患者纳入医院病例统计数据库。根据顾问外科医生和医院的平均年度结直肠癌切除术病例数,将其分为三分位数(低、中、高)。检查的结果指标是术后 30 天死亡率、28 天再入院和再次手术以及住院时间。分层多元回归分析调整了年龄、性别、合并症、社会剥夺、手术年份、手术类型和手术途径。
共纳入 109261 例选择性癌症结直肠切除术。高容量顾问外科医生和医院的定义是每年进行超过 20.7 次和 103.5 次选择性结直肠癌手术。顾问和医院的手术量在整个研究期间都有所增加。在分层回归模型中,外科医生和机构的更高工作量仅独立预测住院时间更短。在更高的提供者数量与术后死亡率、28 天再次手术或再入院率之间未观察到统计学关联。
单独增加选择性结直肠癌的病例量可能会带来轻微的术后益处。