Arch Orthop Trauma Surg. 2013 Dec;133(12):1747-55. doi: 10.1007/s00402-013-1860-0.
Hospital volume has been suggested to be a significant determinant of the outcome of joint replacement surgery. We updated previously published data on the effect of hospital volume on length of stay, re-admissions, and reoperations for total hip replacement (THR) at the population level in Finland.
A total of 54,505 THRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into four groups according to the number of primary and revision total hip and knee arthroplasties performed on an annual basis over the whole study period: 1–199 (group 1), 200–499 (group 2), 500–899 (group 3), and >900 (group 4). We analyzed the association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions and reoperations.
The larger the volume group, the shorter were LOS and LUIC (p < 0.01). According to the adjusted data, risk for re-admission in 42 days was greater in group 1 than in group 4 (OR = 1.14; 95 % CI: 1.05–1.23). There was no difference in the risk for reoperation.
LOS and LUIC ought to be shortened in lower volume hospitals.
医院的手术量被认为是关节置换手术结果的一个重要决定因素。我们更新了先前发表的关于芬兰人群中手术量对全髋关节置换术（THR）住院时间、再入院和再手术影响的资料，纳入了更多的病例。
从住院患者登记处和芬兰关节置换登记处共确定了 1998 年至 2010 年间因原发性骨关节炎行的 54505 例 THR。根据整个研究期间每年进行的初次和翻修全髋关节和膝关节置换手术数量，将医院分为四组：1-199 例（第 1 组）、200-499 例（第 2 组）、500-899 例（第 3 组）和>900 例（第 4 组）。我们分析了医院手术量与住院时间（LOS）、不间断机构护理时间（LUIC）、再入院和再手术之间的关系。
手术量越大，LOS 和 LUIC 越短（p<0.01）。根据调整后的数据，42 天内再入院的风险在第 1 组高于第 4 组（OR=1.14；95%CI：1.05-1.23）。两组间再手术风险无差异。
低手术量医院应缩短 LOS 和 LUIC。
