Bell Teresa M, Boustany Karim C, Jenkins Peter C, Zarzaur Ben L
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana; Eskenazi Health, Indianapolis, Indiana.
J Surg Res. 2015 Jun 15;196(2):350-7. doi: 10.1016/j.jss.2015.02.009. Epub 2015 Feb 13.
Increases in hospital volume are positively associated with improved surgical outcomes. However, in the trauma setting, studies have reported conflicting findings in regard to volume's effect on in-hospital mortality. This study investigates whether complications, failure-to-rescue (FTR), and mortality are influenced by trauma centers' average annual volume.
We performed a retrospective cohort study that analyzed patient records included in the National Trauma Data Bank from years 2008-2010. We calculated risk-adjusted complication, FTR, and mortality rates for centers treating different volumes of patients. We also performed multilevel logistic regression modeling to examine the probability that patients treated at trauma centers with higher annual volumes would experience complication, FTR, and mortality while controlling for injury severity, type of injury, mechanism of trauma, age, gender, race, number of comorbidities, head injury, hypotension, and hospital clustering. Hospital characteristics including designation level, academic status, nonprofit status, safety-net status, and region were incorporated into the model.
Risk-adjusted complication, FTR, and mortality rates differed significantly across hospital volume quintiles. Regression analyses indicated that higher hospital volumes were significantly associated with a decreased likelihood of mortality for individual patient but not for complication or FTR.
Our findings suggest that higher trauma center volume is associated with improved mortality outcomes. However, the relationship between volume and FTR is more complex. Future research should address the question of determining optimal volume levels that lead to high provider experience, efficient resource usage, and low unintended consequences or outcomes.
医院手术量的增加与手术效果的改善呈正相关。然而，在创伤治疗领域，关于手术量对院内死亡率的影响，研究报告的结果相互矛盾。本研究调查创伤中心的年平均手术量是否会影响并发症、未能挽救（FTR）和死亡率。
我们进行了一项回顾性队列研究，分析了2008 - 2010年国家创伤数据库中的患者记录。我们计算了治疗不同患者数量的中心的风险调整并发症、FTR和死亡率。我们还进行了多水平逻辑回归建模，以检验在控制损伤严重程度、损伤类型、创伤机制、年龄、性别、种族、合并症数量、头部损伤、低血压和医院聚类的情况下，在年手术量较高的创伤中心接受治疗的患者发生并发症、FTR和死亡的概率。医院特征包括指定级别、学术地位、非营利地位、安全网地位和地区被纳入模型。
风险调整后的并发症、FTR和死亡率在医院手术量五分位数之间存在显著差异。回归分析表明，较高的医院手术量与个体患者死亡率降低的可能性显著相关，但与并发症或FTR无关。
我们的研究结果表明，较高的创伤中心手术量与死亡率改善相关。然而，手术量与FTR之间的关系更为复杂。未来的研究应解决确定最佳手术量水平的问题，该水平可带来高医疗服务提供者经验、高效资源利用以及低意外后果或结果。
