Lin Xiaojun, Tao Hongbing, Cai Miao, Liao Aihua, Cheng Zhaohui, Lin Haifeng
From the Department of Health Administration, School of Medicine and Health Management (XL, HT, MC, ZC, HL); and Family Planning Research Institute, Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology (AL), Wuhan, China.
Medicine (Baltimore). 2016 Feb;95(5):e2687. doi: 10.1097/MD.0000000000002687.
Previous reviews have suggested that hospital volume is inversely related to in-hospital mortality. However, percutaneous coronary intervention (PCI) practices have changed substantially in recent years, and whether this relationship persists remains controversial.A systematic search was performed using PubMed, Embase, and the Cochrane Library to identify studies that describe the effect of hospital volume on the outcomes of PCI. Critical appraisals of the methodological quality and the risk of bias were conducted independently by 2 authors. Fourteen of 96 potentiality relevant articles were included in the analysis. Twelve of the articles described the relationship between hospital volume and mortality and included data regarding odds ratios (ORs); 3 studies described the relationship between hospital volume and long-term survival, and only 1 study included data regarding hazard ratios (HRs). A meta-analysis of postoperative mortality was performed using a random effects model, and the pooled effect estimate was significantly in favor of high volume providers (OR: 0.79; 95% confidence interval [CI], 0.72-0.86; P < 0.001). A systematic review of long-term survival was performed, and a trend toward better long-term survival in high volume hospitals was observed.This meta-analysis only included studies published after 2006 and revealed that postoperative mortality following PCI correlates significantly and inversely with hospital volume. However, the magnitude of the effect of volume on long-term survival is difficult to assess. Additional research is necessary to confirm our findings and to elucidate the mechanism underlying the volume-outcome relationship.
以往的综述表明，医院规模与住院死亡率呈负相关。然而，近年来经皮冠状动脉介入治疗（PCI）的实践发生了重大变化，这种关系是否仍然存在仍存在争议。我们使用PubMed、Embase和Cochrane图书馆进行了系统检索，以确定描述医院规模对PCI结果影响的研究。由两位作者独立对方法学质量和偏倚风险进行批判性评价。96篇潜在相关文章中有14篇纳入分析。其中12篇文章描述了医院规模与死亡率之间的关系，并包含比值比（OR）数据；3项研究描述了医院规模与长期生存之间的关系，只有1项研究包含风险比（HR）数据。使用随机效应模型对术后死亡率进行荟萃分析，合并效应估计显著支持高容量医疗服务提供者（OR：0.79；95%置信区间[CI]，0.72 - 0.86；P<0.001）。对长期生存进行了系统评价，观察到高容量医院有更好长期生存的趋势。这项荟萃分析仅纳入了2006年后发表的研究，结果显示PCI术后死亡率与医院规模显著负相关。然而，规模对长期生存的影响程度难以评估。需要进一步的研究来证实我们的发现，并阐明规模 - 结果关系背后的机制。
