Cole Tyler, Veeravagu Anand, Zhang Michael, Ratliff John K
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
Clin Spine Surg. 2017 Jun;30(5):E633-E639. doi: 10.1097/BSD.0000000000000238.
Retrospective study using the MarketScan longitudinal database (2006-2010).
Compare complication rates between groups of patients undergoing anterior cervical discectomy and fusion (ACDF) procedures performed by surgeons with high versus low mean annual ACDF volume.
Over the past decade the volume of ACDFs performed has increased, concurrent with greater appreciation of potential for associated complications. The effect of surgeon procedure volume on adverse events occurrence in the postoperative period has not been described.
We evaluated the relationship between surgeon procedure volume and postoperative incidence of any complication using a multivariate logistic regression model. A total of 24,461 patients undergoing single and multiple level ACDFs were identified in the MarketScan database by Current Procedural Terminology coding. Annual surgeon volume was determined by tracking of anonymized surgeon identification numbers, with high-volume surgeons defined as those performing an average of at least 30 ACDF procedures annually.
Over 50% of unique surgeon identifiers reported <9 ACDF operations per year, whereas the highest decile reported a range of 44-101. High surgeon volume was protective for any complication [odds ratio (OR), 72; 95% confidence interval, 0.65-0.81; P<0.0001], with an adjusted number needed to harm of 44. Patients treated by high-volume physicians specifically had lower odds of dysphagia (2.22% vs. 3.08%; OR, 0.71; P<0.0013), neurological complications (0.33% vs. 0.64%; OR, 0.52; P<0.0107), new diagnosis of chronic pain (0.48% vs. 0.82%; OR, 0.58; P<0.0119), pulmonary complications (1.10% vs. 1.58%; OR, 0.69; P<0.0138), and other wound complications (0.06% vs. 0.22%; OR, 0.28; P<0.0242).
We demonstrate a possible association between higher surgeon procedure volume and decreased postoperative complications after ACDF. There was no difference observed in need for revision surgery or readmission rates.
使用市场扫描纵向数据库（2006 - 2010年）进行回顾性研究。
比较由年均颈椎前路椎间盘切除融合术（ACDF）手术量高和低的外科医生实施ACDF手术的患者组之间的并发症发生率。
在过去十年中，ACDF手术量有所增加，同时人们也更加认识到相关并发症的可能性。外科医生手术量对术后不良事件发生的影响尚未见描述。
我们使用多变量逻辑回归模型评估外科医生手术量与任何并发症术后发生率之间的关系。通过当前手术操作术语编码在市场扫描数据库中识别出总共24461例接受单节段和多节段ACDF手术的患者。通过追踪匿名的外科医生识别号码确定年度外科医生手术量，高手术量外科医生定义为每年平均至少进行30例ACDF手术的医生。
超过50%的唯一外科医生识别码报告每年进行的ACDF手术少于9例，而最高十分位数报告的手术量范围为44 - 101例。外科医生高手术量对任何并发症具有保护作用[比值比（OR），0.72；95%置信区间，0.65 - 0.81；P < 0.0001]，调整后的伤害所需人数为44。由高手术量医生治疗的患者发生吞咽困难的几率较低（2.22%对3.08%；OR，0.71；P < 0.0013）、神经并发症（0.33%对0.64%；OR，0.52；P < 0.0107）、新诊断的慢性疼痛（0.48%对0.82%；OR，0.58；P < 0.0119）、肺部并发症（1.10%对1.58%；OR，0.69；P < 0.0138）以及其他伤口并发症（0.06%对0.22%；OR，0.28；P < 0.0242）。
我们证明了外科医生较高的手术量与ACDF术后并发症减少之间可能存在关联。在翻修手术需求或再入院率方面未观察到差异。
