Monn M Francesca, Bahler Clinton D, Flack Chandra K, Dube Hitesh T, Sundaram Chandru P
Department of Urology, Indiana University School of Medicine Indianapolis , Indiana.
J Endourol. 2014 Oct;28(10):1231-6. doi: 10.1089/end.2014.0265. Epub 2014 Aug 13.
We sought to evaluate the relationship between hospital volume and postoperative complications following robot-assisted partial nephrectomy (RAPN) using the Nationwide Inpatient Sample.
We identified patients undergoing RAPN between 2009 and 2011. Hospitals were divided into volume-based tertiles for each year (high, medium, low). Descriptive analyses were performed using Pearson's chi-squared and Student's t-test. Multivariable logistic regression assessed the association between hospital volume and postoperative complications, adjusting for age, gender, hospital region, type of hospital, primary payer, comorbidities, and kidney cancer.
We identified 17,583 cases from 323 hospitals, of which 112 were low volume, 112 medium volume, and 99 high volume. 13,645 (78%) cases were performed at high-volume institutions. Eleven percent of patients developed an in-hospital postoperative complication, with 15% at low-volume, 12% at medium-volume, and 10% at high-volume hospitals (p=0.071). In addition, blood transfusion was less common at high-volume hospitals (p=0.015). On multivariable logistic regression, high-volume hospitals had 42% decreased odds of postoperative in-hospital complications (95% confidence interval 0.37-0.90; p=0.016). Complications were associated with a $4500 increase in hospital costs.
High-volume hospitals are associated with decreased blood transfusions and complications. With the recognition that high-volume RAPN hospitals are independently associated with improved clinical outcomes, further studies should be performed to determine the role of the hospital and surgeon volume thresholds in the performance of RAPN.
我们试图利用全国住院患者样本评估医院手术量与机器人辅助部分肾切除术（RAPN）术后并发症之间的关系。
我们确定了2009年至2011年间接受RAPN的患者。每年将医院按手术量分为三分位数（高、中、低）。使用Pearson卡方检验和学生t检验进行描述性分析。多变量逻辑回归评估医院手术量与术后并发症之间的关联，并对年龄、性别、医院地区、医院类型、主要支付方、合并症和肾癌进行校正。
我们从323家医院中识别出17583例病例，其中手术量低的医院有112家，中等的有112家，高的有99家。13645例（78%）在高手术量机构进行。11%的患者发生了院内术后并发症，低手术量医院为15%，中等手术量医院为12%，高手术量医院为10%（p = 0.071）。此外，高手术量医院输血情况较少见（p = 0.015）。在多变量逻辑回归分析中，高手术量医院术后院内并发症的发生几率降低了42%（95%置信区间0.37 - 0.90；p = 0.016）。并发症与医院成本增加4500美元相关。
高手术量医院与输血和并发症减少相关。鉴于高手术量的RAPN医院与改善临床结局独立相关，应进一步开展研究以确定医院和外科医生手术量阈值在RAPN手术中的作用。
