外科医生手术量对颈椎前路融合术后并发症、住院时间及费用的影响。
Effect of Surgeon Volume on Complications, Length of Stay, and Costs Following Anterior Cervical Fusion.
作者信息
Basques Bryce A, Louie Philip K, Shifflett Grant D, Fice Michael P, Mayo Benjamin C, Massel Dustin H, Guzman Javier Z, Bohl Daniel D, Singh Kern
机构信息
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopedic Surgery, The Mount Sinai Hospital, New York, NY.
出版信息
Spine (Phila Pa 1976). 2017 Mar 15;42(6):394-399. doi: 10.1097/BRS.0000000000001756.
STUDY DESIGN
Retrospective cohort.
OBJECTIVE
To identify the association between surgeon volume and inpatient complications, length of stay, and costs associated with ACF.
SUMMARY OF BACKGROUND DATA
Increased surgeon volume may be associated with improved outcomes after surgical procedures. However, there is a lack of information on the effect of surgeon volume on short-term outcomes after anterior cervical fusion (ACF).
METHODS
A retrospective cohort study of ACF patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Surgeon volume was divided into three categories, volume <25th percentile, 25th to 74th percentile, and ≥75th percentile of surgeon volume. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital costs between surgeon volume categories.
RESULTS
A total of 419,212 ACF patients were identified. The 25th percentile for volume was 5 cases per year, and the 75th percentile for volume was 67 cases per year. Volume <25th percentile was associated with increased rates of any adverse event (odd ratio, OR 3.8, P < 0.001), and multiple individual complications including death (OR 2.5, P=0.014), myocardial infarction (OR4.4, P < 0.001), sepsis (OR 4.1, P < 0.001), and surgical site infection (OR 4.0, P < 0.001). Notably, volume ≥75th percentile was associated with decreased rates of any adverse event (OR 0.7, P < 0.001) and death (OR 0.6, P = 0.028). On multivariate analysis, length of stay was significantly increased by 2.3 days (P < 0.001) for surgeons <25th percentile of volume and was decreased by 0.3 days for surgeons with volume ≥75th percentile. Hospital costs were $4569 more for surgeons with <25th percentile of volume and $1213 less for surgeons with ≥75th percentile volume.
CONCLUSION
In this nationally representative sample, surgeons with volume <25th percentile had significantly increased complications, length of stay, and costs. Conversely, surgeons with ≥75th percentile volume experienced decreased complications, length of stay, and costs.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
确定手术医生手术量与住院并发症、住院时间以及颈椎前路融合术（ACF）相关费用之间的关联。
背景数据总结
手术医生手术量增加可能与手术后更好的结果相关。然而，关于手术医生手术量对颈椎前路融合术（ACF）短期结果的影响，目前缺乏相关信息。
方法
利用2003年至2009年的全国住院患者样本（NIS）对ACF患者进行回顾性队列研究。手术医生手术量分为三类：手术量低于第25百分位数、第25至74百分位数以及手术量≥第75百分位数。采用多因素回归分析比较不同手术医生手术量类别之间的不良事件发生率、住院时间和总住院费用。
结果
共识别出419,212例ACF患者。手术量的第25百分位数为每年5例，第75百分位数为每年67例。手术量低于第25百分位数与任何不良事件发生率增加相关（比值比，OR 3.8，P<0.001），以及多种个体并发症，包括死亡（OR 2.5，P=0.014）、心肌梗死（OR 4.4，P<0.001）、败血症（OR 4.1，P<0.001）和手术部位感染（OR 4.0，P<0.001）。值得注意的是，手术量≥第75百分位数与任何不良事件发生率降低（OR 0.7，P<0.001）和死亡发生率降低（OR 0.6，P=0.028）相关。多因素分析显示，手术量低于第25百分位数的医生住院时间显著增加2.3天（P<0.001），而手术量≥第75百分位数的医生住院时间减少0.3天。手术量低于第25百分位数的医生住院费用多出4569美元，而手术量≥第75百分位数的医生住院费用少1213美元。
结论
在这个具有全国代表性的样本中，手术量低于第25百分位数的医生并发症、住院时间和费用显著增加。相反，手术量≥第75百分位数的医生并发症、住院时间和费用降低。
证据级别
4级。
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