Nguyen Geoffrey C, Steinhart A Hillary
*Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; †Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; and ‡Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
Inflamm Bowel Dis. 2014 Feb;20(2):301-6. doi: 10.1097/01.MIB.0000438247.06595.b9.
High hospital procedural volume has been associated with better postoperative inflammatory bowel disease outcomes. We assessed the independent contribution of surgeon volume to health outcomes after surgery for Crohn's disease.
We identified 2842 individuals with Crohn's disease who underwent first inflammatory bowel disease-related surgery between 1996 and 2009. We assessed the association between surgeon volume, hospital volume, comorbidity and demographic variables, and postoperative outcomes.
The in-hospital mortality rate was 4.4%. Being in the lowest income, quintile was associated with 3-fold higher mortality compared with the highest income quartile (odds ratio, 3.10; 95% CI, 1.44-6.48). The late hospitalization (>3 mo after surgery) rate among those operated by surgeons in the bottom quartile for inflammatory bowel disease surgery volume was nearly 1.5-fold higher than that of those operated by surgeons in the second, third, and top quartiles (3.4/100 person-years [py] versus 2.4/100 py, 2.1/100 py, and 2.3/100 py, respectively; P < 0.05). After multivariate adjustment, the relative incidence ratio for late hospitalization for surgeons in the second, third, and top quartiles were 0.88 (95% CI, 0.83-0.93), 0.88 (95% CI, 0.83-0.94), and 0.87 (95% CI, 0.79-0.94) compared with the bottom quartile, respectively. The 5-year risk of recurrent surgery was 24.3%, and was not associated with surgeon volume.
Low surgeon volumes were associated with increased risk of late hospitalizations after Crohn's disease surgery. Prospective studies are warranted to elucidate whether this correlation is a late-onset consequence of surgical inexperience or other healthcare utilization factors that are associated with lower surgeon volume.
医院手术量高与炎症性肠病术后更好的预后相关。我们评估了外科医生手术量对克罗恩病手术后健康结局的独立影响。
我们确定了1996年至2009年间接受首次炎症性肠病相关手术的2842例克罗恩病患者。我们评估了外科医生手术量、医院手术量、合并症和人口统计学变量与术后结局之间的关联。
住院死亡率为4.4%。收入处于最低五分位数的患者死亡率比最高收入四分位数的患者高3倍（比值比，3.10；95%置信区间，1.44 - 6.48）。炎症性肠病手术量处于最低四分位数的外科医生所做手术患者的晚期住院率（手术后>3个月）比处于第二、第三和最高四分位数的外科医生所做手术患者高出近1.5倍（分别为3.4/100人年、2.4/100人年、2.1/100人年和2.3/100人年；P < 0.05）。多因素调整后，与最低四分位数相比，第二、第三和最高四分位数的外科医生晚期住院的相对发病率分别为0.88（95%置信区间，0.83 - 0.93）、0.88（95%置信区间，0.83 - 0.94）和0.87（95%置信区间，0.79 - 0.94）。再次手术的5年风险为24.3%，且与外科医生手术量无关。
外科医生手术量低与克罗恩病手术后晚期住院风险增加相关。有必要进行前瞻性研究以阐明这种相关性是手术经验不足的晚期后果还是与外科医生手术量较低相关的其他医疗利用因素。
