Al-Qurayshi Z, Robins R, Buell J, Kandil E
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States.
A.B. Freeman School of Business, Tulane University, New Orleans, LA, United States.
Eur J Surg Oncol. 2016 Oct;42(10):1483-90. doi: 10.1016/j.ejso.2016.06.392. Epub 2016 Jun 23.
The number of adrenal surgeries performed in the United Stated is continuing to increase. Identifying factors associated with favorable outcomes can have a major impact on cost-differences. We aim to assess the impact of surgeon volume on both clinical outcomes and cost following adrenal surgery.
A cross-sectional analysis was performed utilizing data from the Nationwide Inpatient Sample, 2003-2009. Surgeon volumes included (adrenalectomies/year): low-volume (1), intermediate-volume (2-6), and high-volume (≥7).
A total of 7045 patients were included. Surgeries performed by low-volume surgeons were associated with a higher risk of postoperative complications [OR: 1.66, 95% CI: (1.23, 2.24)]. During the study period, if all operations performed by low-volume surgeons were selectively referred to intermediate-volume surgeons, a 7.7% cost savings would have been incurred. Potential savings were even higher (8.1%) if the operations had been performed by the high-volume surgeons. With the conservative assumption that there are 5000 adrenalectomies per year in the United States, the high-volume surgeons would produce savings of $8.8 million over a span of 14 years.
A surgeon's expertise is associated with favorable outcomes. Our model estimates that considerable cost savings are attainable with appropriate referrals to high volume endocrine surgeons.
在美国，肾上腺手术的数量持续增加。确定与良好预后相关的因素可能对成本差异产生重大影响。我们旨在评估外科医生手术量对肾上腺手术后临床结局和成本的影响。
利用2003年至2009年全国住院患者样本数据进行横断面分析。外科医生的手术量包括（每年肾上腺切除术数量）：低手术量（1例）、中等手术量（2至6例）和高手术量（≥7例）。
共纳入7045例患者。低手术量外科医生进行的手术与术后并发症风险较高相关[比值比：1.66，95%置信区间：（1.23，2.24）]。在研究期间，如果低手术量外科医生进行的所有手术都选择性地转诊给中等手术量外科医生，成本将节省7.7%。如果这些手术由高手术量外科医生进行，潜在节省甚至更高（8.1%）。基于美国每年有5000例肾上腺切除术这一保守假设，高手术量外科医生在14年的时间里将节省880万美元。
外科医生的专业技能与良好的预后相关。我们的模型估计，适当转诊给高手术量的内分泌外科医生可实现可观的成本节省。
