利用2001年至2012年台湾地区全民健保数据分析外科医生手术量和医院手术量与游离组织移植结局的相关性
Associations of Surgeon and Hospital Volumes with Outcome for Free Tissue Transfer by Using the National Taiwan Population Health Care Data from 2001 to 2012.
作者信息
Mahmoudi Elham, Lu Yiwen, Chang Shu-Chen, Lin Chia-Yu, Wang Yi-Chun, Chang Chee Jen, Cheng Ming-Huei, Chung Kevin C
机构信息
Ann Arbor, Mich.; and Taoyuan, Taiwan.
From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School; the Research Services Center for Health Information and Graduate Institute of Clinical Medicine, Chang Gung University; and the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University.
出版信息
Plast Reconstr Surg. 2017 Sep;140(3):455e-465e. doi: 10.1097/PRS.0000000000003593.
BACKGROUND
Greater hospital case volumes are associated with improved outcomes for high-risk procedures. The hospital-outcome association for complex but low-mortality procedures and the association between surgeon versus hospital case volume and surgical outcomes have been less explored. The authors examined the association between surgeon and hospital volume and the success for free tissue transfer (free flap) surgery. The authors hypothesized that there would be positive associations between hospital and surgeon volume and the success of free flap surgery.
METHODS
The study design was a cross-sectional analysis of adults aged 18 to 64 years who underwent free flap surgery. The authors used 100 percent of all free flap operations between 2001 and 2012 using Taiwan's national data that cover the entire population of 23 million in the country. The authors applied hierarchical regression modeling to analyze volume-outcome associations.
RESULTS
The association between hospital volume and free flap success was small but positive (OR, 1.007; 95 percent CI, 1.00 to 1.01). For surgeons, their years of experience had a positive association with success of the operation (OR, 1.04; 95 percent CI, 1.02 to 1.06) rather than their annual case volume. Compared with low-volume surgeons (<11 annual cases) working in low-volume hospitals (<95 annual cases), high-volume surgeons (>25 annual cases) working in high-volume hospitals (>156 annual cases) showed greater odds of operation success (OR, 2.97; 95 percent CI, 1.21 to 7.29).
CONCLUSIONS
Higher volume hospitals and more experienced surgeons, regardless of their annual volume, showed better outcomes. Increasing demand for high-quality care and Taiwan's national policies toward centralization of complex surgical procedures have increased competition among hospitals.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
较高的医院病例数量与高风险手术的更好预后相关。对于复杂但低死亡率的手术，医院预后关联以及外科医生与医院病例数量和手术结果之间的关联研究较少。作者研究了外科医生和医院手术量与游离组织移植（游离皮瓣）手术成功率之间的关联。作者假设医院和外科医生手术量与游离皮瓣手术成功率之间存在正相关。
方法
研究设计为对18至64岁接受游离皮瓣手术的成年人进行横断面分析。作者使用了2001年至2012年期间台湾全国数据中100%的游离皮瓣手术，该数据涵盖了全国2300万的全部人口。作者应用分层回归模型分析手术量与预后的关联。
结果
医院手术量与游离皮瓣手术成功率之间的关联虽小但呈正相关（比值比，1.007；95%置信区间，1.00至1.01）。对于外科医生，他们的经验年限与手术成功率呈正相关（比值比，1.04；95%置信区间，1.02至1.06），而非其年度病例数量。与在低手术量医院（<95例/年）工作的低手术量外科医生（<11例/年）相比，在高手术量医院（>156例/年）工作的高手术量外科医生（>25例/年）手术成功的几率更高（比值比，2.97；95%置信区间，1.21至7.29）。
结论
手术量较高的医院和经验更丰富的外科医生，无论其年度手术量如何，预后均更佳。对高质量医疗服务需求的增加以及台湾针对复杂外科手术集中化的国家政策，加剧了医院之间的竞争。
临床问题/证据级别：治疗性，III级
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