De la Garza-Ramos Rafael, Abt Nicholas B, Kerezoudis Panagiotis, Krauss William, Bydon Mohamad
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
J Clin Neurosci. 2016 Feb;24:43-6. doi: 10.1016/j.jocn.2015.08.008. Epub 2015 Sep 26.
This study aimed to analyze the impact of surgeon and hospital volume on short-term outcomes following surgery for spinal metastases. Data from the Nationwide Inpatient Sample (NIS; 2003-2009) were extracted. Patients who underwent decompression and/or fusion for metastatic spinal tumors were identified via International Classification of Diseases, Ninth Revision codes. Surgeon and hospital volume were evaluated as a continuous variable. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (OR) of in-hospital mortality, post-operative complication development, non-routine discharges, prolonged length of stay, and high hospital charges with increasing surgeon and hospital volume. In total 3,069 admissions were examined. The overall in-hospital mortality rate was 4.4% and in-hospital complication rate 29.7%; non-routine discharges occurred in 63.3% of patients. Increasing provider volume was not associated with lower odds of in-hospital mortality. However, increasing surgeon volume was associated with significantly lower odds of developing an in-hospital complication (OR 0.70; 95% confidence interval [CI], 0.58-0.85) and having a non-routine discharge (OR 0.76; 95% CI, 0.66-0.87). Increasing hospital volume was not associated with lower odds of developing a post-operative complication (OR 1.17; 95% CI, 1.00-1.37), but was associated with lower odds of having a non-routine discharge (OR 0.83; 95% CI, 0.73-0.95). Patients operated on by higher volume surgeons were less likely to have a prolonged length of stay (over 14 days); higher hospital volume was associated with increased odds of high hospital charges (over $295,511 USD). In this study utilizing the NIS administrative database, patients with metastatic spinal tumors treated by higher volume surgeons had significantly lower complication rates, were more likely to be discharged home following surgery, and were less likely to have a prolonged length of stay. Increasing hospital volume was associated with lower non-routine discharge rates, but with higher hospital charges. Better outcomes with higher volume surgeons may be a reflection of patient selection, and further research is needed to corroborate our findings.
本研究旨在分析外科医生手术量和医院手术量对脊柱转移瘤手术后短期结局的影响。提取了来自全国住院患者样本（NIS；2003 - 2009年）的数据。通过国际疾病分类第九版编码确定接受转移性脊柱肿瘤减压和/或融合手术的患者。将外科医生手术量和医院手术量作为连续变量进行评估。进行多变量逻辑回归分析，以计算随着外科医生手术量和医院手术量增加，住院死亡率、术后并发症发生、非常规出院、住院时间延长以及高额住院费用的调整比值比（OR）。总共检查了3069例入院病例。总体住院死亡率为4.4%，住院并发症发生率为29.7%；63.3%的患者出现非常规出院情况。外科医生手术量增加与住院死亡率降低的几率无关。然而，外科医生手术量增加与住院并发症发生几率显著降低（OR 0.70；95%置信区间[CI]，0.58 - 0.85）以及非常规出院几率降低（OR 0.76；95% CI，0.66 - 0.87）相关。医院手术量增加与术后并发症发生几率降低无关（OR 1.17；95% CI，1.00 - 1.37），但与非常规出院几率降低相关（OR 0.83；95% CI，0.73 - 0.95）。由手术量较高的外科医生进行手术的患者住院时间延长（超过14天）的可能性较小；医院手术量较高与高额住院费用（超过295,511美元）的几率增加相关。在这项利用NIS行政数据库的研究中，由手术量较高的外科医生治疗的转移性脊柱肿瘤患者并发症发生率显著较低，术后更有可能回家出院，且住院时间延长的可能性较小。医院手术量增加与非常规出院率降低相关，但与住院费用增加相关。手术量较高的外科医生取得更好的结局可能反映了患者选择因素，需要进一步研究来证实我们的发现。
