Department of Surgery, McMaster University, Hamilton, ON, Canada.
Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
Surg Endosc. 2017 Nov;31(11):4816-4823. doi: 10.1007/s00464-017-5559-0. Epub 2017 Apr 13.
Previous data demonstrate that patients who receive bariatric surgery at a Center of Excellence are different than those who receive care at non-accredited centers. Canada provides a unique opportunity to naturally exclude confounders such as insurance status, hospital ownership, and lack of access on comparisons between hospitals and surgeons in bariatric surgery outcomes. The objective of this study was to determine the effect of hospital accreditation and other health system factors on all-cause morbidity after bariatric surgery in Canada.
This was a population-based study of all patients aged ≥18 who received a bariatric procedure in Canada (excluding Quebec) from April 2008 until March 2015. The main outcomes for this study were all-cause morbidity and costs during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24 h or required reoperation. Risk-adjusted hierarchical regression models were used to determine predictors of morbidity and cost.
Overall, 18,398 patients were identified and the all-cause morbidity rate was 10.1%. Surgeon volume and teaching hospitals were both found to significantly decrease the odds of all-cause morbidity. Specifically, for each increase in 25 bariatric cases per year, the odds of all-cause morbidity was 0.94 times lower (95% CI 0.87-1.00, p = 0.03). Teaching hospitals conferred a 0.75 lower odds of all-cause morbidity (95% CI 0.58-0.95, p < 0.001). Importantly, formal accreditation was not associated with a decrease in all-cause morbidity within a universal healthcare system. No health system factors were associated with significant cost differences.
This national cohort study found that surgeon volume and teaching hospitals predicted lower all-cause morbidity after surgery while hospital accreditation was not a significant factor.
先前的数据表明，在卓越中心接受减重手术的患者与在非认证中心接受治疗的患者不同。加拿大提供了一个独特的机会，可以在比较减重手术结果时，自然排除保险状况、医院所有权和缺乏准入等混杂因素。本研究的目的是确定医院认证和其他卫生系统因素对加拿大减重手术后全因发病率的影响。
这是一项基于人群的研究，纳入了 2008 年 4 月至 2015 年 3 月期间在加拿大（魁北克除外）接受减重手术的所有年龄≥18 岁的患者。本研究的主要结局是指数住院期间的全因发病率和费用。全因发病率包括任何延长住院时间 24 小时或需要再次手术的有记录的并发症。使用风险调整的层次回归模型来确定发病率和费用的预测因素。
总体而言，共确定了 18398 例患者，全因发病率为 10.1%。手术医生的手术量和教学医院都被发现显著降低了全因发病率的可能性。具体来说，每年每增加 25 例减重手术，全因发病率的可能性就降低 0.94 倍（95%CI 0.87-1.00，p=0.03）。教学医院使全因发病率的可能性降低了 0.75 倍（95%CI 0.58-0.95，p<0.001）。重要的是，在全民医疗保健体系中，正式认证与全因发病率的降低无关。没有卫生系统因素与显著的成本差异相关。
这项全国性队列研究发现，手术医生的手术量和教学医院可以预测手术后的全因发病率降低，而医院认证不是一个重要因素。
