Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
Department of Statistics, University of California, Irvine, Irvine, California, CA, USA.
Surg Endosc. 2017 Oct;31(10):4224-4230. doi: 10.1007/s00464-017-5482-4. Epub 2017 Mar 24.
There is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals.
We reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume.
A total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48-15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38-10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39-10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81-0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12-0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02).
There was a small but significant inverse relationship between the hospitals' case volume and mortality in laparoscopic diaphragmatic hernia repair.
目前尚无关于腹腔镜膈疝修补术中医院手术量与结局之间关系的发表数据。我们假设手术量大的医院的治疗效果要好于手术量小的医院。
我们对 2008 年至 2012 年期间国家住院患者样本数据库（NIS）中接受择期腹腔镜膈疝修补术和/或尼森胃底折叠术的成人膈疝患者进行了回顾性分析。排除小儿、急症和开放性病例。主要观察指标包括对根据医院年手术量预测住院死亡率和结果的因素进行逻辑回归分析。
共分析了 31228 例腹腔镜膈疝手术。总的院内死亡率为 0.14%。更高的院内死亡率的危险因素包括肾衰竭（OR：6.26；95%CI：2.48-15.78；p<0.001）、年龄>60 岁（OR：5.06；95%CI：2.38-10.76；p<0.001）和充血性心力衰竭（OR：3.80；95%CI：1.39-10.38；p=0.009），而每年手术量增加 10 例（OR：0.89；95%CI：0.81-0.98；p=0.019）和糖尿病（OR：0.34；95%CI：0.12-0.93；p=0.036）则降低死亡率。医院手术量与死亡率之间存在微小但显著的负相关关系，每年增加 10 例手术可使调整后的住院死亡率降低 10%。使用每年 10 例作为手术量的阈值，低手术量医院（≤10 例/年）的死亡率几乎是高手术量医院（0.23%比 0.12%，p=0.02）的两倍。
腹腔镜膈疝修补术中医院手术量与死亡率之间存在微小但显著的负相关关系。
