Wes Ari M, Mazzaferro Daniel, Naran Sanjay, Hopkins Edward, Bartlett Scott P, Taylor Jesse A
Philadelphia, Pa.
From the Division of Plastic Surgery, Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2017 Nov;140(5):711e-718e. doi: 10.1097/PRS.0000000000003763.
The relationships between hospital/surgeon characteristics and operative outcomes and cost are being scrutinized increasingly. In patients with craniosynostosis specifically, the relationship between hospital volume and outcomes has yet to be characterized.
Subjects undergoing craniosynostosis surgery between 2004 and 2015 were identified in the Pediatric Health Information System. Outcomes were compared between two exposure groups, those undergoing treatment at a high-volume institution (>40 cases per year), and those undergoing treatment at a low-volume institution (40 cases per year). Primary outcomes were any complication, prolonged length of stay, and increased total cost.
Over 13,000 patients (n = 13,112) from 49 institutions met inclusion criteria. In multivariate regression analyses, subjects treated in high-volume centers were less likely to experience any complication (OR, 0.764; p < 0.001), were less likely to have an extended length of stay (OR, 0.624; p < 0.001), and were less likely to have increased total cost (OR, 0.596; p < 0.001). Subjects undergoing strip craniectomy in high-volume centers were also less likely to have any complication (OR, 0.708; p = 0.018) or increased total cost (OR, 0.51; p < 0.001). Subjects undergoing midvault reconstruction in high-volume centers were less likely to experience any complications (OR, 0.696; p = 0.002), have an extended length of stay (OR, 0.542; p < 0.001), or have increased total cost (OR, 0.495; p < 0.001).
In hospitals performing a high volume of craniosynostosis surgery, subjects had significantly decreased odds of experiencing a complication, prolonged length of stay, or increased total cost compared with those undergoing treatment in low-volume institutions.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
医院/外科医生的特征与手术结果及成本之间的关系正受到越来越多的审视。特别是在患有颅缝早闭的患者中，医院手术量与治疗结果之间的关系尚未明确。
在儿科健康信息系统中识别出2004年至2015年间接受颅缝早闭手术的患者。比较两个暴露组的治疗结果，一组在高手术量机构（每年>40例）接受治疗，另一组在低手术量机构（每年≤40例）接受治疗。主要结果包括任何并发症、住院时间延长和总成本增加。
来自49家机构的超过13000名患者（n = 13112）符合纳入标准。在多变量回归分析中，在高手术量中心接受治疗的患者发生任何并发症的可能性较小（OR，0.764；p < 0.001），住院时间延长的可能性较小（OR，0.624；p < 0.001），总成本增加的可能性较小（OR，0.596；p < 0.001）。在高手术量中心接受条状颅骨切除术的患者发生任何并发症（OR，0.708；p = 0.018）或总成本增加（OR，0.51；p < 0.001）的可能性也较小。在高手术量中心接受中颅穹窿重建术的患者发生任何并发症（OR，0.696；p = 0.002）、住院时间延长（OR，0.542；p < 0.001）或总成本增加（OR，0.495；p < 0.001）的可能性较小。
在进行大量颅缝早闭手术的医院中，与在低手术量机构接受治疗的患者相比，接受治疗的患者发生并发症、住院时间延长或总成本增加的几率显著降低。
临床问题/证据水平：治疗性，III级。
