De la Garza Ramos Rafael, Nakhla Jonathan, Nasser Rani, Jada Ajit, Bhashyam Niketh, Kinon Merritt D, Yassari Reza
Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
World Neurosurg. 2017 Sep;105:543-548. doi: 10.1016/j.wneu.2017.05.060. Epub 2017 May 19.
To investigate the effects of surgeon volume on inpatient morbidity after 1- and 2-level anterior cervical discectomy and fusion (ACDF).
Data from the Nationwide Inpatient Sample from 2009 were extracted. All adult patients who underwent an elective 1- or 2-level ACDF for degenerative cervical spine disease were identified. Surgeon volume was analyzed as a continuous and categorical variable: very low (<12 procedures per year), low (12-23 procedures per year), medium (24-35 procedures per year), high (36-47 procedures per year), and very high (≥48 procedures per year). A multivariate logistical regression analysis was performed to calculate the adjusted odds ratios of overall in-hospital and surgical complication occurrence in relation to surgeon volume.
Eleven thousand two hundred forty-nine admissions were analyzed. The overall complication rate was 4.7%, and the surgical complication rate was 1.2%. Following regression analysis, increasing surgeon volume (evaluated continuously) was independently associated with lower odds of overall complication (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P < 0.001) and surgical complication development (OR, 0.98; 95% CI, 0.97-0.99; P = 0.004). Surgeons with very high volume (performing 48 or more procedures per year; 4 or more per month) showed a significant decrease in overall complications (OR, 0.58; 95% CI, 0.41-0.84; P = 0.003) and surgical complications (OR, 0.52; 95% CI, 0.25-0.99; P = 0.041) when compared to surgeons with very low volume.
In this study, increasing surgeon volume was independently associated with significantly lower odds of perioperative complications following 1- and 2-level ACDF. Performing 4 or more procedures per month was associated with the lowest complication rate.
探讨手术医生手术量对1级和2级颈椎前路椎间盘切除融合术（ACDF）后患者住院期间发病率的影响。
提取2009年全国住院患者样本的数据。确定所有因退行性颈椎病接受择期1级或2级ACDF的成年患者。手术医生手术量作为连续变量和分类变量进行分析：极低（每年<12例手术）、低（每年12 - 23例手术）、中（每年24 - 35例手术）、高（每年36 - 47例手术）和极高（每年≥48例手术）。进行多因素逻辑回归分析，以计算与手术医生手术量相关的总体住院和手术并发症发生的调整比值比。
分析了11249例入院病例。总体并发症发生率为4.7%，手术并发症发生率为1.2%。回归分析后，手术医生手术量增加（连续评估）与总体并发症发生几率降低独立相关（比值比[OR]，0.99；95%置信区间[CI]，0.98 - 0.99；P < 0.001）以及手术并发症发生（OR，0.98；95% CI，0.97 - 0.99；P = 0.004）。与手术量极低的医生相比，手术量极高（每年进行48例或更多手术；每月4例或更多）的医生总体并发症（OR，0.58；95% CI，0.41 - 0.84；P = 0.003）和手术并发症（OR，0.52；95% CI，0.25 - 0.99；P = 0.041）显著降低。
在本研究中，手术医生手术量增加与1级和2级ACDF术后围手术期并发症发生几率显著降低独立相关。每月进行4例或更多手术与最低并发症发生率相关。
