外科医生手术量是否会影响发展中国家全膝关节置换术的结果？——一项回顾性队列研究。
Does surgeon volume affect the outcome of total knee arthroplasties in a developing country? - A retrospective cohort study.
作者信息
Malik Azeem Tariq, Mufarrih Syed Hamza, Ali Arif, Noordin Shahryar
机构信息
Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
出版信息
Ann Med Surg (Lond). 2017 Oct 28;24:38-43. doi: 10.1016/j.amsu.2017.10.025. eCollection 2017 Dec.
INTRODUCTION
Recent studies have shown that in addition to patient factors, surgeon volume has influenced total knee arthroplasty (TKA) outcomes greatly. With recent propositions of regionalization of arthroplasties to higher volume centers, the need for further evidence is warranted.
MATERIALS AND METHODS
Retrospective Cohort Study done at Aga Khan University Hospital, Pakistan from January 2007 to December 2015. High Volume (HV) group was set as at least 50 TKAs/year and Low Volume (LV) was set as at most 25 TKAs/year. A total of 615 patients undergoing a unilateral or bilateral TKA were included in our study.
RESULTS
LV group was associated with a higher length of stay (LOS) as compared to HV group in patients undergoing a bilateral TKA after adjusted logistic regression [OR 2.395 (1.47,3.91)]. We found no association between surgeon volume and postoperative complications.
CONCLUSION
Patients getting a bilateral TKA by LV surgeons were twice more likely to have a longer LOS as compared to HV group. Further research is warranted comparing all aspects and possible confounders to different variables before a conclusion can be made.
引言
最近的研究表明，除了患者因素外，外科医生的手术量对全膝关节置换术（TKA）的结果有很大影响。随着最近提出将关节置换手术集中到手术量更高的中心，有必要提供进一步的证据。
材料与方法
在巴基斯坦阿迦汗大学医院进行的回顾性队列研究，时间跨度为2007年1月至2015年12月。高手术量（HV）组定义为每年至少进行50例TKA手术，低手术量（LV）组定义为每年最多进行25例TKA手术。我们的研究共纳入了615例行单侧或双侧TKA手术的患者。
结果
在调整逻辑回归后，双侧TKA患者中，LV组的住院时间（LOS）比HV组更长[比值比2.395（1.47，3.91）]。我们发现外科医生手术量与术后并发症之间没有关联。
结论
与HV组相比，由LV外科医生进行双侧TKA手术的患者住院时间延长的可能性高出两倍。在得出结论之前，有必要进一步研究比较不同变量的各个方面和可能的混杂因素。
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