利用单一机构的临床和行政数据库对3725例重叠神经外科手术与3633例非重叠神经外科手术的患者结局进行比较。
Comparison of Patient Outcomes in 3725 Overlapping vs 3633 Nonoverlapping Neurosurgical Procedures Using a Single Institution's Clinical and Administrative Database.
作者信息
Zygourakis Corinna C, Keefe Malla, Lee Janelle, Barba Julio, McDermott Michael W, Mummaneni Praveen V, Lawton Michael T
机构信息
Department of Neurological Surgery , University of California, San Francisco, California, USA.
Center for Healthcare Value, University of California, San Francisco, California, USA.
出版信息
Neurosurgery. 2017 Feb 1;80(2):257-268. doi: 10.1093/neuros/nyw067.
BACKGROUND
Overlapping surgery is a common practice to improve surgical efficiency, but there are limited data on its safety.
OBJECTIVE
To analyze the patient outcomes of overlapping vs nonoverlapping surgeries performed by multiple neurosurgeons.
METHODS
Retrospective review of 7358 neurosurgical procedures, 2012 to 2015, at an urban academic hospital. Collected variables: patient age, gender, insurance, American Society of Anesthesiologists score, severity of illness, mortality risk, admission type, transfer source, procedure type, surgery date, number of cosurgeons, presence of neurosurgery resident/fellow/another attending, and overlapping vs nonoverlapping surgery. Outcomes: procedure time, length of stay, estimated blood loss, discharge location, 30-day mortality, 30-day readmission, return to operating room, acute respiratory failure, and severe sepsis. Statistics: univariate, then multivariate mixed-effect models.
RESULTS
Overlapping surgery patients (n = 3725) were younger and had lower American Society of Anesthesiologists scores, severity of illness, and mortality risk (P < .0001) than nonoverlapping surgery patients (n = 3633). Overlapping surgeries had longer procedure times (214 vs 172 min; P < .0001), but shorter length of stay (7.3 vs 7.9 d; P = .010) and lower estimated blood loss (312 vs 363 mL’s; P = .003). Overlapping surgery patients were more likely to be discharged home (73.6% vs 66.2%; P < .0001), and had lower mortality rates (1.3% vs 2.5%; P = .0005) and acute respiratory failure (1.8% vs 2.6%; P = .021). In multivariate models, there was no significant difference between overlapping and nonoverlapping surgeries for any patient outcomes, except for procedure duration, which was longer in overlapping surgery (estimate = 23.03; P < .001).
CONCLUSIONS
When planned appropriately, overlapping surgery can be performed safely within the infrastructure at our academic institution.
背景
重叠手术是提高手术效率的常用方法，但关于其安全性的数据有限。
目的
分析多位神经外科医生进行重叠手术与非重叠手术的患者结局。
方法
回顾性分析2012年至2015年在一家城市学术医院进行的7358例神经外科手术。收集的变量包括：患者年龄、性别、保险类型、美国麻醉医师协会评分、疾病严重程度、死亡风险、入院类型、转诊来源、手术类型、手术日期、共同手术医生数量、是否有神经外科住院医师/研究员/另一位主治医生以及重叠手术与非重叠手术。结局指标包括：手术时间、住院时间、估计失血量、出院地点、30天死亡率、30天再入院率、返回手术室情况、急性呼吸衰竭和严重脓毒症。统计方法：单因素分析，然后进行多因素混合效应模型分析。
结果
重叠手术患者（n = 3725）比非重叠手术患者（n = 3633）更年轻，美国麻醉医师协会评分、疾病严重程度和死亡风险更低（P <.0001）。重叠手术的手术时间更长（214分钟对172分钟；P <.0001），但住院时间更短（分别为7.3天和7.9天；P =.010），估计失血量更低（312毫升对363毫升；P =.003）。重叠手术患者更有可能出院回家（73.6%对66.2%；P <.0001），死亡率更低（1.3%对2.5%；P =.0005），急性呼吸衰竭发生率更低（1.8%对2.6%；P =.021）。在多因素模型中，除手术持续时间外，重叠手术与非重叠手术在任何患者结局方面均无显著差异，重叠手术的手术持续时间更长（估计值 = 23.03；P <.001）。
结论
在我们学术机构的基础设施内，经过适当规划，重叠手术可以安全进行。
Zotero 插件