Ono Sachiko, Ishimaru Miho, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Graduate Student, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Assistant Professor, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Oral Maxillofac Surg. 2015 Nov;73(11):2219-24. doi: 10.1016/j.joms.2015.04.003. Epub 2015 Apr 13.
Cleft lip and cleft palate are the most common craniofacial anomalies. However, the effect of hospital volume on outcomes of surgery for cleft lip and palate is unknown.
The Japanese Diagnosis Procedure Combination database was searched to identify patients who underwent surgery for cleft lip and palate from July 2010 through March 2013. Hospital volume was divided into tertiles (≤28, 29 to 82, and ≥83 admissions/yr). Outcomes included total cost, length of hospital stay, duration of anesthesia, and length of antibiotic use. The relation between hospital volume and surgical outcomes was analyzed by multivariable regression analyses.
The authors identified 7,405 admissions for cleft lip alone, cleft palate alone, or cleft lip and palate during the study period. Compared with the reference low-volume hospital category, a shorter duration of anesthesia was seen in the medium-volume group (-15 minutes; 95% confidence interval, -37 to 7 minutes) and high-volume group (-22 minutes; 95% confidence interval, -65 to 3 minutes). No statistical associations were observed between hospital volume and total cost or length of stay. Although not statistically important, a higher hospital volume was associated with a shorter length of antibiotic use after adjusting for duration of anesthesia.
In the present study of surgical outcomes for cleft lip and palate, hospital volume was inversely associated with duration of anesthesia and length of antibiotic use, but was not statistically associated with length of hospital stay or total cost.
唇腭裂是最常见的颅面畸形。然而，医院手术量对唇腭裂手术结局的影响尚不清楚。
检索日本诊断程序组合数据库，以确定2010年7月至2013年3月期间接受唇腭裂手术的患者。医院手术量分为三分位数（≤28例、29至82例和≥83例/年）。结局指标包括总费用、住院时间、麻醉持续时间和抗生素使用时长。通过多变量回归分析来分析医院手术量与手术结局之间的关系。
作者在研究期间确定了7405例单纯唇裂、单纯腭裂或唇腭裂患者的入院病例。与低手术量医院的参考类别相比，中等手术量组的麻醉持续时间较短（-15分钟；95%置信区间，-37至7分钟），高手术量组的麻醉持续时间也较短（-22分钟；95%置信区间，-65至3分钟）。未观察到医院手术量与总费用或住院时间之间存在统计学关联。尽管无统计学意义，但在调整麻醉持续时间后，较高的医院手术量与较短的抗生素使用时长相关。
在本项关于唇腭裂手术结局的研究中，医院手术量与麻醉持续时间和抗生素使用时长呈负相关，但与住院时间或总费用无统计学关联。
